Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
Neurocrit Care. 2010 Jun;12(3):369-74. doi: 10.1007/s12028-010-9335-4.
Infections are a well-known cause of cerebral vasculopathy and vasculitis. We aimed to analyze the frequency of intracranial vasculopathy attributable to infection, the spectrum of causative microorganisms, imaging, and cerebrospinal fluid (CSF) characteristics as well as clinical course and outcome.
We used our institution's medical record system to identify all patients diagnosed with nonatherosclerotic central nervous system vasculopathy from January 1, 1999 through February 28, 2009. We reviewed their clinical charts, imaging data, and results of CSF studies.
Twenty-five adult patients with nonatherosclerotic cerebral vasculopathy of large- and medium-sized intracranial vessels were identified. Eight patients had vasculopathy attributable to infection (32%). The underlying pathologies were acute bacterial meningitis (n = 4), varicella zoster virus (VZV) infection (n = 2), borreliosis (n = 1), and syphilis (n = 1). In six patients, magnetic resonance angiography was performed and showed vasculopathic changes in all patients examined (100%). In both patients with VZV-associated vasculopathy, the arterial wall enhanced on magnetic resonance imaging. The CSF examination of the patients with infectious vasculopathy showed a significantly higher white blood cell count. The outcome of the infectious cohort was unfavorable with one death, two patients with locked-in syndrome, and five patients discharged from intensive care with severe neurological deficits.
In this cohort, one-third of all cases of nonatherosclerotic vasculopathy were due to infectious vasculopathy of large and medium intracranial vessels.
感染是引起脑血管病和血管炎的已知原因。我们旨在分析颅内血管病归因于感染的频率、致病微生物的范围、影像学和脑脊液（CSF）特征以及临床病程和结局。
我们使用机构的病历系统，从 1999 年 1 月 1 日至 2009 年 2 月 28 日，确定所有诊断为非动脉粥样硬化性中枢神经系统血管病的成年患者。我们回顾了他们的临床图表、影像学数据和 CSF 研究结果。
确定了 25 例成人非动脉粥样硬化性颅内大、中血管血管病患者。8 例血管病归因于感染（32%）。潜在病理学为急性细菌性脑膜炎（n=4）、水痘带状疱疹病毒（VZV）感染（n=2）、伯氏疏螺旋体病（n=1）和梅毒（n=1）。6 例患者进行了磁共振血管造影，所有检查患者均显示血管病变（100%）。在 2 例 VZV 相关血管病患者中，磁共振成像显示动脉壁增强。感染性血管病患者的 CSF 检查显示白细胞计数明显升高。感染组的结局不佳，1 例死亡，2 例闭锁综合征，5 例重症监护后出院，伴有严重神经功能缺损。
在本队列中，三分之一的非动脉粥样硬化性血管病是由颅内大、中血管的感染性血管病引起的。
