The Role of Catheter Angiography in the Diagnosis of Central Nervous System Vasculitis

Background: Central nervous system vasculitis (CNSV) is a rare disorder, the pathophysiology of which is not fully understood. It involves a combination of inflammation and thrombosis. CNSV is most commonly associated with headache, gradual changes in mental status, and focal neurological symptoms. Diagnosis requires the effective use of history, laboratory testing, imaging, and biopsy. Catheter angiography can be a powerful tool in the diagnosis when common and low-frequency angiographic manifestations of CNSV are considered. We review these manifestations and their place in the diagnostic algorithm of CNSV. Summary: We reviewed the PubMed database for case series of CNSV that included 5 or more patients. Demographic and angiographic findings were collected. Angiographic findings were dichotomized between common and low-frequency findings. A system for incorporating these findings into clinical decision-making is proposed. Key Message: CNSV is a diagnostic challenge due to the absence of a true gold standard test. In the absence of such a test, catheter angiography remains a central piece of the diagnostic puzzle when appropriately employed and interpreted.

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Adult primary central nervous system vasculitis. A case-series

Journal of the Neurological Sciences ◽

10.1016/j.jns.2021.118840 ◽

2021 ◽

Vol 429 ◽

pp. 118840

Author(s):

Silvio Piffer ◽

Raffaella Tanel ◽

Roberto Bortolotti ◽

Umberto Rozzanigo ◽

Bruno Giometto ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Case Series ◽

Central Nervous System Vasculitis

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Central Nervous System Vasculitis for Cryptococcosis in an Immunocompetent Patient

Diseases ◽

10.3390/diseases6030075 ◽

2018 ◽

Vol 6 (3) ◽

pp. 75 ◽

Cited By ~ 1

Author(s):

Dan Zimelewicz Oberman ◽

Liliana Patrucco ◽

Carolina Cuello Oderiz

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Cryptococcus Neoformans ◽

Cryptococcal Meningitis ◽

Fungal Pathogen ◽

Immunocompetent Patient ◽

Central Nervous System Vasculitis ◽

Diagnostic Challenge ◽

Threatening Condition ◽

Life Threatening

Cryptococcal meningitis is a life-threatening condition caused by a fungal pathogen, Cryptococcus neoformans, that can infect both immunosuppressed and immunocompetent hosts. It is an important cause of morbidity and mortality in severely immunodeficient patients. However, in an immunocompetent patient it represents a diagnostic challenge, mainly because it is extremely rare, but also because of its nonspecific clinical manifestation. Neurovascular involvement in cryptococcal meningitis is rare and not well known and only few reports have described this association. We describe a cryptococcal meningitis in an immunocompetent patient associated with central nervous system vasculitis.

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Central nervous system vasculitis in a patient with HIV infection: a diagnostic challenge

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170163 ◽

2017 ◽

Vol 75 (12) ◽

pp. 897-898 ◽

Cited By ~ 1

Author(s):

Nícolas de O. Amui ◽

Roberta G. F. Silva ◽

Danilo M. C. Costa ◽

Orlando G. P. Barsottini ◽

José Luiz Pedroso ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Hiv Infection ◽

Central Nervous System Vasculitis ◽

Diagnostic Challenge

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Selected Biomarkers of Tick-Borne Encephalitis: A Review

International Journal of Molecular Sciences ◽

10.3390/ijms221910615 ◽

2021 ◽

Vol 22 (19) ◽

pp. 10615

Author(s):

Monika Gudowska-Sawczuk ◽

Barbara Mroczko

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Clinical Decision Making ◽

White Blood Cells ◽

Clinical Decision ◽

Second Phase ◽

Inflammatory Reactions ◽

Tick Borne Encephalitis ◽

Pubmed Database ◽

The Central Nervous System

Tick-borne encephalitis (TBE) is an acute disease caused by the tick-borne encephalitis virus. Due to the viral nature of the condition, there is no effective causal treatment for full-blown disease. Current and nonspecific TBE treatments only relieve symptoms. Unfortunately, the first phase of TBE is characterized by flu-like symptoms, making diagnosis difficult during this period. The second phase is referred to as the neurological phase as it involves structures in the central nervous system—most commonly the meninges and, in more severe cases, the brain and the spinal cord. Therefore, it is important that early markers of TBE that will guide clinical decision-making and the choice of treatment are established. In this review, we performed an extensive search of literature reports relevant to biomarkers associated with TBE using the MEDLINE/PubMed database. We observed that apart from routinely determined specific immunoglobulins, free light chains may also be useful in the evaluation of intrathecal synthesis in the central nervous system (CNS) during TBEV infection. Moreover, selected metalloproteinases, chemokines, or cytokines appear to play an important role in the pathogenesis of TBE as a consequence of inflammatory reactions and recruitment of white blood cells into the CNS. Furthermore, we reported promising findings on tau protein or Toll-like receptors. It was also observed that some people may be predisposed to TBE. Therefore, to understand the role of selected tick-borne encephalitis biomarkers, we categorized these factors and discussed their potential application in the diagnosis, prognosis, monitoring, or management of TBE.

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DIAGNOSTIC VALUE OF SPECIFIC ANTIBODY SYNTHESIS IN BRAIN OF PATIENTS WITH NEUROINFECTIONS

Wiadomości Lekarskie ◽

10.36740/wlek201908103 ◽

2019 ◽

Vol 72 (8) ◽

pp. 1437-1441

Author(s):

Pavel Dyachenko ◽

Igor Filchakov ◽

Anatoly Dyachenko ◽

Victoria Kurhanskaya

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Clinical Manifestations ◽

Diagnostic Value ◽

Diagnostic Challenge ◽

Specific Antibodies ◽

Intrathecal Synthesis ◽

Varicella Zoster ◽

Mrz Reaction ◽

Wide Range

Introduction: Viral encephalitis accounts for 40-70% of all cases worldwide, central nervous system infections pose a diagnostic challenge because clinical manifestations are not typically pathognomonic for specific pathogens, and a wide range of agents can be causative. The aim: To assess the diagnostic value of intrathecal synthesis of specific antibodies in patients with inflammatory lesions of the central nervous system. Materials and methods: Within the framework of the study, two groups of 90 people in each were formed from the patients with neuroinfections admitted to our Center. Intrathecal synthesis (ITS) of total (unspecific) IgG in members of one of group (group of compare) was determined. Brain synthesis of specific antibodies (Ab) to some neurotropic pathogens (herpes simplex virus 1/2, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, rubella virus, Borrelies) was studied in the second group of patients (group of interest). There were no statistically significant differences between groups by gender and age. Encephalitis and encephalomyelitis prevailed among patients of both groups Results: ITS of total IgG was established in 30 (33.3 ± 6.1 %) patients of the first group with IgG index more than 0.6 indicating on inflammatory process in CNS and no marked changes of CSF. ITS of specific Ab was determined in 23 of 90 (25.6 ± 4.6 %) patients included into group of interest. In more than half of cases Ab to several infectious agents were detected simultaneously. ITS of various specificity, in particular, to measles and rubella viruses, and VZV, known as MRZ-reaction, is characteristic of some autoimmune lesions of CNS, multiple sclerosis first of all. In fact, further research of 5 patients with MRZ-reaction confirmed their autoimmune failure of CNS. Detection of ITS in the CSF samples didn’t depend on concentration of specific Ab in serum and CSF and wasn’t followed by HEB dysfunctions which were observed with the same frequency in patients with or without ITS (13.0 % and 13.6 % respectively). Conclusion: Specific Ab synthesis to several neurotropic pathogens in the CSF of significant part of examined patients was established. Thus, diagnostic value of ITS of specific immunoglobulins seems to be limited to cases in which autoimmune damage of the CNS is suspected.

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Primary lymphomatoid granulomatosis of the central nervous system: a diagnostic challenge

Neurología (English Edition) ◽

10.1016/j.nrleng.2020.09.001 ◽

2021 ◽

Author(s):

A. Moreno-Estébanez ◽

T. González-Pinto ◽

G. Agirre-Beitia ◽

L.M. González

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Lymphomatoid Granulomatosis ◽

Diagnostic Challenge ◽

System A ◽

The Central Nervous System

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Central Nervous System Vasculitis as a Rare Presentation of Mycoplasma pneumoniae: A Case Report

Case Reports in Neurology ◽

10.1159/000510632 ◽

2020 ◽

Vol 12 (3) ◽

pp. 402-409

Author(s):

Ashraf Omer Elamin Ahmed ◽

Mona Mohammad Ibraheem Babikir ◽

Amir Elssoni Mahjoup Khojali ◽

Suresh Nalaka Menik Arachchige ◽

Abdirahman Mohamud Abdirahman ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Central Nervous System Involvement ◽

Lower Respiratory Tract Infections ◽

Central Nervous System Vasculitis ◽

Rare Presentation ◽

Systemic Involvement ◽

Tract Infections

<i>Mycobacteria pneumoniae</i> (MP) commonly causes upper and lower respiratory tract infections. The clinical manifestation is classified as pulmonary and extrapulmonary. These manifestations vary according to the involved system. MP may affect one system or more at a time. Commonly prodromal respiratory symptoms precede systemic involvement. Central nervous system involvement in uncommon. This report is presenting a rare case of central nervous system vasculitis secondary to MP, highlighting the diagnosis and management with a succinct literature review.

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