CNS Vasculitis Flashcards
When yo consider CNS vasculitis?
- Lack of CV risk factors to explain Sx
- Multiple strokes without explanation
- Abnormal imaging MRA
- Inflammatory CSF
What is the gold standard for diagnosis
Brain Bx not only to conform but to rule out other causes such as malignancy
A patient has typical findings for CNS vasculitis, what else could it be?
What is the characteristic of headache on CNS vasculitis
Insidious onset, NOT thunderclap or sudden
Specificity of direct (Cerebral angiogram) and indirect (MRA,CTA)
Only about 25%!!! WTF!! DOESN’T RULE IN OR TULE OUT THE DIAGNOSIS
Diagnostic considerations for abnormal imaging looking like CNS vasculitis but normal CSF
- RCVS
- Early atherosclerosis
What is an essential part for workup of CNS vasculitis
CSF since imaging is crap
The patient is presenting with multiple strokes without an explained cause and has normal imaging (CTA, MRA, Cerebral angiogram) but inflammatory CSF. Can it still be CNS vasculitis? If yes, what is the best test?
Yes it can be because imaging is crappy… if you have small vessel disease, you WOULD certainly miss it.
Go for a BRAIN BIOPSY
Can inflammatory markers be normal in CNS vasculitis
Yes, specifically in primary CNS vasculitis
What should always be on your mind when you are evaluating for CNS vasculitis
Infection and malignancy!! ALWAYS
Which infections should CERTAINLY be ruled out for CNS vasculitis
Syphylis
TB
VZV
Acute encephalitis panel
Universal PCR or Next gen testing can be considered
Aqauporin-4 antibiotic is seen in —-
NMO
What is the problem with a brain PET scan because otherwise it’s a fantastic idea?
TOO MUCH ARTIFACT from the skull
What about a whole body PET
Only to figure out if there is a systemic process
What is the patient doesn’t respond to IV CYC
They SHOULD have responded
1. Make sure dose is good
2. Make sure there is not other diagnosis —> get a brain Bx
3. If all the above are negative —> can switch to oral CYC (they have higher cumulative dose and would do better)
