High-resolution Intracranial Vessel Wall Imaging in Monitoring Treatment Response in Primary CNS Angiitis

Georgios Tsivgoulis, Georgios N. Papadimitropoulos, Stefanos Lachanis, Lina Palaiodimou, Christina Zompola, Roubina Antonellou, Konstantinos Voumvourakis

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)188-190
Number of pages3
JournalNeurologist
Volume23
Issue number6
DOIs
StatePublished - Nov 1 2018
Externally publishedYes

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Vasculitis
National Institutes of Health (U.S.)
Stroke
Central Nervous System Vasculitis
Pathology
Anterior Cerebral Artery
Ambulatory Electrocardiography
Digital Subtraction Angiography
Magnetic Resonance Angiography
Methylprednisolone
Middle Cerebral Artery
Internal Carotid Artery
Therapeutics
Cyclophosphamide
Glucocorticoids
Cerebrospinal Fluid
Echocardiography
Magnetic Resonance Imaging
Brain
Proteins

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Tsivgoulis, G., Papadimitropoulos, G. N., Lachanis, S., Palaiodimou, L., Zompola, C., Antonellou, R., & Voumvourakis, K. (2018). High-resolution Intracranial Vessel Wall Imaging in Monitoring Treatment Response in Primary CNS Angiitis. Neurologist, 23(6), 188-190. https://doi.org/10.1097/NRL.0000000000000198

High-resolution Intracranial Vessel Wall Imaging in Monitoring Treatment Response in Primary CNS Angiitis. / Tsivgoulis, Georgios; Papadimitropoulos, Georgios N.; Lachanis, Stefanos; Palaiodimou, Lina; Zompola, Christina; Antonellou, Roubina; Voumvourakis, Konstantinos.

In: Neurologist, Vol. 23, No. 6, 01.11.2018, p. 188-190.

Research output: Contribution to journalArticle

Tsivgoulis, G, Papadimitropoulos, GN, Lachanis, S, Palaiodimou, L, Zompola, C, Antonellou, R & Voumvourakis, K 2018, 'High-resolution Intracranial Vessel Wall Imaging in Monitoring Treatment Response in Primary CNS Angiitis', Neurologist, vol. 23, no. 6, pp. 188-190. https://doi.org/10.1097/NRL.0000000000000198
Tsivgoulis, Georgios ; Papadimitropoulos, Georgios N. ; Lachanis, Stefanos ; Palaiodimou, Lina ; Zompola, Christina ; Antonellou, Roubina ; Voumvourakis, Konstantinos. / High-resolution Intracranial Vessel Wall Imaging in Monitoring Treatment Response in Primary CNS Angiitis. In: Neurologist. 2018 ; Vol. 23, No. 6. pp. 188-190.
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