Role of High-Resolution Magnetic Resonance Imaging in the Diagnosis of Primary Angiitis of the Central Nervous System
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background Primary angiitis of the central nervous system (PACNS) is a rare disorder and isoften difficult to diagnose due to the lack of a confirmatory test. PACNS can generally be diagnosed based on typical angiographic findings. We describe herein a patient diagnosed with PACNSdespite the presence of normal findings on conventional angiography. Case Report A 44-year-old man with a recent history of ischemic stroke in the right posteriorcerebral artery territory developed acute-onset vertigo. Diffusion-weighted imaging revealed anacute infarction within the left posterior inferior cerebellar artery. His medical history was unremarkable except for hyperlipidemia; the initial examination revealed mild gait imbalance. Duringthe 10 days of hospital admission, the patient experienced four recurrent ischemic strokes withinthe posterior circulation territory (occipital lobe, pons, and cerebellum). He was diagnosed withrecurrent cerebral infarctions due to PACNS. The basilar artery exhibited no demonstrable luminal stenosis, but there were direct imaging signs of central nervous system angiitis including wallthickening and contrast enhancement. High-dose intravenous steroid therapy followed by oralprednisolone was administered. There was no further stroke recurrence and follow-up imagingof the arterial walls showed normalization of their characteristics. Conclusions The present case emphasizes the importance of wall imaging in the diagnosis andtreatment of PACNS.
Abstract
Background Primary angiitis of the central nervous system (PACNS) is a rare disorder and isoften difficult to diagnose due to the lack of a confirmatory test. PACNS can generally be diagnosed based on typical angiographic findings. We describe herein a patient diagnosed with PACNSdespite the presence of normal findings on conventional angiography. Case Report A 44-year-old man with a recent history of ischemic stroke in the right posteriorcerebral artery territory developed acute-onset vertigo. Diffusion-weighted imaging revealed anacute infarction within the left posterior inferior cerebellar artery. His medical history was unremarkable except for hyperlipidemia; the initial examination revealed mild gait imbalance. Duringthe 10 days of hospital admission, the patient experienced four recurrent ischemic strokes withinthe posterior circulation territory (occipital lobe, pons, and cerebellum). He was diagnosed withrecurrent cerebral infarctions due to PACNS. The basilar artery exhibited no demonstrable luminal stenosis, but there were direct imaging signs of central nervous system angiitis including wallthickening and contrast enhancement. High-dose intravenous steroid therapy followed by oralprednisolone was administered. There was no further stroke recurrence and follow-up imagingof the arterial walls showed normalization of their characteristics. Conclusions The present case emphasizes the importance of wall imaging in the diagnosis andtreatment of PACNS.
참고문헌 (13)
- Salvarani C, "Primary central nervous system vasculitis: analysis of 101 patients", Ann Neurol, 62, pp.442~451 (2007)
- Hajj-Ali RA, "Primary angiitis of the CNS", Lancet Neurol, 10, pp.561~572 (2011)
- Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172in Acute Stroke Treatment", Stroke, 24, pp.35~41 (1993)
- Küker W, "Cerebral vasculitis: imaging signs revisited", Neuroradiology, 49, pp.471~479 (2007)
- Molloy ES, "Vasculitis mimics", Curr Opin Rheumatol, 20, pp.29~34 (2008)
- Scolding NJ, "Central nervous system vasculitis", Semin Immunopathol, 31, pp.527~536 (2009)
- Calabrese LH, "Primary angiitis of the central nervous system. Report of 8 new cases, review of the literature, and proposal for diagnostic criteria", Medicine (Baltimore), 67, pp.20~39 (1988)
- Cupps TR, "Isolated angiitis of the central nervous system. Prospective diagnostic and therapeutic experience", Am J Med, 74, pp.97~105 (1983)
- Alhalabi M, "Serial angiography in isolated angiitis of the central nervous system", Neurology, 44, pp.1221~1226 (1994)
- Küker W, "Vessel wall contrast enhancement: a diagnostic sign of cerebral vasculitis", Cerebrovasc Dis, 26, pp.23~29 (2008)
- Kissin EY, "Diagnostic imaging in Takayasu arteritis", Curr Opin Rheumatol, 16, pp.31~37 (2004)
- Swartz RH, "Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI", Neurology, 72, pp.627~634 (2009)
- Saam T, "High-resolution black-blood contrast-enhanced T1 weighted images for the diagnosis and follow-up of intracranial arteritis", Br J Radiol, 83, pp.e182~e184 (2010)