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Abstract Details

Magnetic Resonance Vessel Wall Imaging in Central Nervous System Vasculitides: a Case-Series
Cerebrovascular Disease and Interventional Neurology
P10 - Poster Session 10 (5:30 PM-6:30 PM)
4-019
We report three patients with central nervous system (CNS) vasculitis, in which vessel wall imaging (VWI) findings were instrumental in diagnosis and subsequent management.   
High-resolution magnetic resonance VWI is a non-invasive tool to assess intracranial vascular disease, yet its application in routine neurovascular practice is currently limited. 

Case 1: A 33-year-old male presented with cerebellar infarcts and vertebral dissections.  Digital subtraction angiography (DSA) demonstrated no sign of vasculopathy.  VWI revealed concentric thickening and enhancement of right posterior cerebral and left anterior choroidal arteries.  Serum and CSF analysis revealed high titers of Human Herpesvirus type 6. 

Case 2: A 56-year-old male with HSV1 encephalitis was treated and mental status improved.  Surveillance neuroimaging, however, revealed ongoing pathology, including MCA territory distal hyperintense vessels.  VWI revealed middle cerebral artery (MCA) concentric smooth contrast enhancement. 

Case 3: A 41-year-old obese female with hypertension and tobacco use presented with recurrent transient ischemic attacks. Computed topography angiography demonstrated bilateral MCA stenosis.  Patient refused DSA.  VWI revealed uniform enhancement and thickening of the arterial wall.  A calf rash biopsy diagnosed a mixed connective tissue disease.

In cases 1 and 2, VWI visualized vasculitic changes that were crucial to proper diagnoses of viral arteriopathies.  In case 3, VWI findings led to a diagnosis of mixed connective tissue disease prompting immunotherapy in a patient with stenoocclusive disease that was initially attributed to atherosclerosis.  In every case, VWI will provide a noninvasive modality to track intracranial vasculopathy progression and response to treatment. 

Etiological diagnosis of intracranial vasculopathies remains challenging. Whereas traditional angiographic modalities depict vessel lumen appearance, they provide very limited information regarding arterial wall integrity and pathology. Conversely, the underlying vasculitic process has typical imaging characteristics on VWI, as illustrated in our case-series. In order to provide targeted therapy, clinicians should take advantage of the nuanced information VWI provides.  
Authors/Disclosures
Matthew Padrick, MD (Seton Ascension Neurology)
PRESENTER 		Dr. Padrick has nothing to disclose.
No disclosure on file
Shlee S. Song, MD (Cedars-Sinai Medical Center) Dr. Song has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NINDS. Dr. Song has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA/ASA. Dr. Song has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Hodes Milman. The institution of Dr. Song has received research support from DISCOVERY.
Kyle Ogami, MD No disclosure on file
Nicholas Szumski, MD (Cedars-Sinai Medical Group -- Neurology) No disclosure on file
No disclosure on file
Oana M. Dumitrascu, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) Dr. Dumitrascu has nothing to disclose.