Diagnosis of microvasculopathy in CNS vasculitis: value of perfusion and diffusion imaging

Imaging the Vasculitides

"Neuroimaging plays a vital role in the diagnosis of primary and secondary vasculitic disorders. There multiple neuroimaging options available to accurately describe the underlying clinical deficits of involved cases. Noninvasive neuroimaging modalities provide less risk and when interdigitated, form the basis for a more conclusive understanding of the disease process. There are instances in which invasive cerebral angiography may be needed to image the intricate and at times, small involved vessels. Neuroradiologists should be included in the multidisciplinary team of physicians caring for patients with vasculitides and in research to provide more sensitive and safe modalities for accurate diagnosis."

Primary angiitis of the central nervous system: differential diagnosis and treatment

While primary angiitis of the central system (PACNS) remains a rare entity, the poor specificity of the available diagnostic tests and its multiple mimics create a major diagnostic challenge. Recently, there have been advances in understanding PACNS and differentiating it from its mimics. A recent breakthrough is the proposal of reversible cerebral vasoconstriction syndromes (RCVS) as a unifying concept for a group of disorders that highly mimics PACNS. RCVS are characterised by acute-onset, recurrent headaches, with or without additional neurologic events, with reversible vasoconstriction of the central nervous system (CNS) vasculatures, mimicking CNS vasculitis. RCVS are considered the most common mimics of PACNS. Advances in our understanding of RCVS have allowed for identification of patients previously confused with PACNS. The scope of this article focusses on the work-up, differential diagnosis and evaluation of PACNS, as well as a discussion of the secondary CNS vasculitides with emphasis on their clinical findings, diagnoses and treatment.

Steroid-responsive large vessel vasculitis: application of whole-brain 320-detector row dynamic volume CT angiography and perfusion

SUMMARY

A patient with suspected giant cell arteritis and prior negative findings on superficial temporal artery biopsy was evaluated with 320-detector row CT angiography (CTA) and whole-brain perfusion. Corticosteroid treatment was initiated on the basis of CT angiography findings of arteritis and a cortical perfusion deficit. The patient's symptoms and perfusion imaging findings resolved following therapy. Whole-brain CTA and imaging was helpful in the diagnosis and monitoring this patient with suspected vasculitis.

Diffusion-weighted imaging in chronic Behçet patients with and without neurological findings

Our aim was to investigate whether neurological impairment in chronic Behçet's disease (BD) patients with normal appearing brain can be assessed by means of diffusion-weighted imaging (DWI). The averaged apparent diffusion coefficient (ADC) values were calculated in 22 different radiologically normal appearing brain regions in 32 patients with and without neurological findings and 20 control subjects. The ADC values in bilateral frontal, temporal and occipital normal appearing white matter were significantly higher in the patient groups compared with the control subjects (p < 0.05). In these brain regions, DWI revealed differences in the ADC values between patients with neurological findings (including symptomatic and neuro-Behçet patients) and the asymptomatic patient group. The similarity of the ADC values of patients without symptoms to those of the control group allowed clear discrimination between patients with and without neurological findings. DWI may serve to assess subclinical neurological involvement in BD, even when structural changes are absent.

Primary central nervous system angiitis, amyloid angiopathy, and alzheimer's pathology presenting with balint's syndrome

We report a patient who presented with Balint's syndrome as a manifestation of primary central nervous system angiitis. Clinical findings included simultanagnosia, optic ataxia, and optic apraxia. Pathologic evaluation demonstrated amyloid angiopathy and Alzheimer's plaques. The presence of primary central nervous system angiitis along with amyloid angiopathy and Alzheimer's plaques may not be coincidental. Angiitis may be a foreign body reaction to A4 amyloid deposition.

Lupus vasculitis: differential diagnosis with antiphospholipid syndrome

The inflammatory process of systemic lupus erythematosus (SLE) vasculitis occurs in up to 56% of patients with SLE, whereas the vaso-occlusive incidence of antiphospholipid syndrome in SLE (which is not exclusive of SLE vasculitis) reaches up to 15%. Both situations can be life-threatening, requiring the appropriate therapeutic approach. Aggressive anti-inflammatory therapy is used in the case of SLE vasculitis and aggressive antithrombotic/anticoagulant treatment in the other. However, often the differential diagnosis between the two entities is difficult to achieve, especially when a tissue biopsy to help establish the diagnosis is topographically difficult to obtain or is clinically contraindicated. Such situations are discussed and appropriate guidelines for a correct diagnosis suggested.

Cerebral vasculitis: diagnosis and follow-up with transcranial Doppler ultrasonography

The authors report a patient with postpartum intracerebral hemorrhage associated with cerebral vasculitis. Cerebral circulation was assessed with transcranial Doppler (TCD) ultrasonography, magnetic resonance angiography, and conventional cerebral angiography. Initial TCD studies demonstrated bilateral patchy increased cerebral blood flow velocity (CBFV) in the anterior circulation with complete normalization during remission. This case report provides evidence that cerebral vasculitis leads to relevant CBFV changes and that the TCD technique may assist in diagnosis and follow-up of these patients.