Τίτλος:
High-resolution Intracranial Vessel Wall Imaging in Monitoring Treatment Response in Primary CNS Angiitis
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Introduction:High-resolution vessel wall imaging (HR-VWI) is emerging as a tool of notable utility in the diagnosis of intracranial vessel pathology. Its role in monitoring vessel wall disease response to treatment, however, is less well-established.Case Report:We report the case of a 45-year-old man with left middle and anterior cerebral artery infarcts and an National Institute of Health Stroke Scale (NIHSS) score of 2. Time-of-flight magnetic resonance angiography and digital subtraction angiography showed multifocal intracranial vessel pathology without extracranial vessel involvement. Comprehensive investigation with echocardiography and 24 hours Holter electrocardiography was unrevealing and the coagulation and routine autoimmune panel results were within normal limits. Cerebrospinal fluid showed mildly elevated protein and a diagnosis of probable primary central nervous system (PCNS) angiitis was made. The diagnosis was corroborated by intracranial HR-VWI, which showed homogenous, concentric enhancement of the left supraclinoid internal carotid artery (ICA) wall. The patient received high-dose IV methylprednisolone and cyclophosphamide. Repeat brain magnetic resonance imaging with HR-VWI at 3 and 9 months showed reduction and final resolution of vessel wall enhancement without recurrent infarcts. He has since remained clinically stable with an NIHSS score of 0 on low-dose oral glucocorticoids.Conclusions:Our report illustrates the utility of HR-VWI in diagnosing a case of PCNS angiitis through the demonstration of a vasculitic pattern of mural enhancement. Furthermore, it has provided evidence of disease response to treatment, assisting us in modifying treatment accordingly. Tracking disease activity and response to treatment in cases of central nervous system vasculitis can be another important use of HR-VWI in clinical practice besides assisting in establishing the diagnosis. © 2018 Lippincott Williams and Wilkins.
Συγγραφείς:
Tsivgoulis, G.
Papadimitropoulos, G.N.
Lachanis, S.
Palaiodimou, L.
Zompola, C.
Antonellou, R.
Voumvourakis, K.
Περιοδικό:
The Neurologist
Εκδότης:
Lippincott Williams and Wilkins
Λέξεις-κλειδιά:
cyclophosphamide; glucocorticoid; methylprednisolone, adult; anterior cerebral artery; anterior cerebral artery stenosis; Article; brain infarction; brain vasculitis; case report; Caucasian; cerebrospinal fluid analysis; clinical article; drug megadose; drug pulse therapy; drug response; hemiparesis; high resolution vessel wall imaging; Holter monitoring; human; leukocyte count; low drug dose; magnetic resonance angiography; male; middle aged; middle cerebral artery occlusion; National Institutes of Health Stroke Scale; nuclear magnetic resonance imaging; occlusive cerebrovascular disease; paresthesia; polymerase chain reaction; priority journal; repeat procedure; serology; transesophageal echocardiography; transthoracic echocardiography; treatment response
DOI:
10.1097/NRL.0000000000000198
