Convexity Subarachnoid Hemorrhage Secondary to Adalidumab in a Patient with Ulcerative Colitis

The TNF-α antagonists are the drugs used for the treatment of ulcerative colitis (UC). Nontraumatic convexity subarachnoid hemorrhage is an infrequent nonaneurysmal subtype of subarachnoid bleeding caused
mainly by reversible cerebral vasoconstriction syndrome (RCVS), cerebral amyloid angiopathy, and posterior reversible encephalopathy syndrome (PRES).
We present a 26-year-old female patient with a diagnosis of UC taking Adalimumab. She received her last
doses the same day she was admitted to our hospital for an acute severe UC exacerbation. Steroids were
added to the treatment. Five days after admission she presented a thunderclap headache with photophobia,
nausea, and vomiting. An MRI was performed showing left frontal convexity subarachnoid hemorrhage
and hyperintense lesions on T2-weighted and FLAIR sequences located in both occipital lobes, left cerebellar hemisphere, and brainstem. Digital angiography was unremarkable. Adalimumab was discontinued but
persisted on treatment with steroids. The patient evolved with complete resolution of her symptoms and
was discharged with a normal neurological exam. Two months later, she was asymptomatic and her MRI
revealed superficial siderosis secondary to cSAH with resolution of white matter hyperintensities.