Naslov
A case of cerebral vasculitis in a 58-year-old patient presenting with acute stroke.

Autori
Čandrlić, Marija ; Bitunjac, Milan ; Ažman, Dražen ; Galić, Martina

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Abstract Book / - , 2017, 92-93

Skup
57th International neuropsychiatric congress

Mjesto i datum
Pula, Hrvatska, 24.05.2017. - 27.05.2017

Vrsta sudjelovanja
Poster

Vrsta recenzije
Recenziran

Ključne riječi
cerebral vasculitis ; acute stroke ; case report

Sažetak
Introduction/Objectives: A range of different vasculitides can affect cerebral blood vessels. When a cerebral vasculitis is detected, in an absence of other underlying cause, including other vasculitis symptoms, inflammatory diseases or cancer, it is usually termed primary angiitis of CNS (PACNS) or CNS vasculitis. PACNS is a rare disorder which involves medium-sized and small blood vessels. Leading symptoms of cerebral vasculitis are stroke, headache and encephalopathy and diagnosis is based on laboratory findings and neuroimaging. Establishing a definite diagnosis is challenging due to limitations of available diagnostic modalities with a high probability of false positive or false negative results. A brain biopsy is occasionally required. Recommendations for treatment of cerebral angiitis are based on protocols for systemic vasculitis treatment guidelines. Participants, Materials/Methods: A 58-year-old male has been admitted to our department with clinical presentation of stroke. Sensomotor aphasia, right-sided central facial palsy and plegia of right-sided extremities. NIHSS at initial exam was 21. He had a history of chronic arterial hypertension, was treated for encephalitis 5 years earlier, as well as for lung tuberculosis and left leg DVT. He also noticed a rash on his lower extremities, which was bioptized and a diagnose of leukocytoclastic vasculitis was established. Patient was treated with intravenous rtPA, and partial neurological improvement was observed (NIHSS 8). Laboratory values did not show any abnormalities (including SE, protein electrophoresis, tumor markers, ANA, ANCA, RF, Waaler-Rose test). Brain MR revealed hemorrhagic transformation of ischemic lesions in basal ganglia in left hemisphere with multiple chronic post-ischemic lesions. Thorax and abdomen MSCT scan, as well as trans-thoracic echocardiography was normal. Finally, cerebral panangiography was performed, revealing multi-focal segmental narrowing of terminal branches of both ACM, both ACA and both ACP which supported the diagnosis of CNS vasculitis. Patient was treated with pulse corticosteroid therapy (1000mg of intravenous SoluMedrol over 5 days). Cyclophosphamide (1000mg) was also administered as one-dose-per month scheme over 4 months which was well tolerated by the patient. Two more treatments with cyclophosphamide are planned. Conclusions: We presented here a patient with acute stroke due to CNS vasculitis. Patient was initially thrombolysed with beneficial outcome, and was subsequently treated according to protocols for systemic vasculitis. Definite diagnosis could be confirmed with brain biopsy.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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