Vasculitis | Brain

Vasculitis Brain

Ashley DAvidoff MD

Definition

Arteritis, (aka angiitis, or vasculitis) is an inflammatory condition of the arteries of the brain.

The disease is most commonly caused by diseases of immune origin such as the collagen vascular disorders. Wegener’s granulomatosis polyarteritis nodosa, systemic lupus erythematosus (SLE), rheumatoid arthritis and Behçet’s disease are entities that are associated with cerebral vasculitis. Drug related causes are another common etiology particulalrly particular amphetamine, cocaine and heroin. Malignancy is another cause and in paticular lymphoma, leukemia and lung cancer. Sometimes infection is the cause.

Clinically it may produce a wide range of neurological symptoms, such as headache, sensory changes, motor disorders alterations of higher function such as changes of perception, thought or behaviour.

Imaging usually requires the resolution of conventional angiography to make the diagnosis but MRA or CTA may show the areas of spasm which are the pathognomonic findings.

Treatment is usually with steroids and may require additional immunosuppresion with cyclophosphamides.

Vasospasm in the Anterior Cerebral Artery – Vasculitis

The angiogram is from a 62 year old female patient is with acute neurological deficit The intracerebral angiogram shows focal regions of spasm with one area of spasm in the callosomarginal branch (white arrow) and two foci within the pericallosal artery (red arrows) .

DWI – Multicentric Infarction – Acute Vasculitis

The diffusion weighted MRI is from a 62 year old female patient is with acute neurological deficit The DWI sequence reveals multicentric of restricted diffusion indicating acute infarction. In image a, the dominant infarction is in the right frontal lobe, but there is an area of infarction in the left frontal lobe as well. Image b shows restricted diffusion in the periventricular white matter, while (c) shows disease in the posterior parietal region. In image (d) an infarction of the right side of the pons is apparent.

Acute Infarction in the Pons – Vasculitis

The diffusion weighted MRI is from a 62 year old female patient is with acute neurological deficit The DWI sequence in image (a) reveals a focus of restricted diffusion in the pons. This finding is confirmed on the T 2weighted image (b) as well as on FLAIR on the axial FLAIR (c) and coronal FLAIR(d). On the last image – the coronal image shows FLAIR hyperintensity dominant in the right white matter particularly in the corona radiate. These findings are consistent with an acute infarction in the pons and the multicentricty is compatible with the diagnosis of vasculitis.

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