Prevention of recurrence depends on control of blood pressure, review of the need for anticoagulation, and surgical or other management of arteriovenous malformations (Fig 3) or underlying neoplasms. Special problems arise when the hemorrhage is due to an underlying vasculitis. Cocaine use (either chronic or reuse after a period of withdrawal) may trigger hemorrhage. In some the bleed is due to hypertension-provoking hemorrhage from an arteriovenous malformation rather than a vasculitis, but the drug must be stopped in either case. In systemic vasculitis steroids and immunosuppression may be relevant.
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