Departments of Neurology.
Imaging.
Neurologist. 2020 Nov;25(6):174-177. doi: 10.1097/NRL.0000000000000298.
We aim to report 3 cases of central nervous system (CNS) vasculitides, in which high-resolution magnetic resonance vessel wall imaging (HR-VWI) findings were instrumental in the diagnosis and management.
Case 1: A 41-year-old obese, smoker female with arterial hypertension presented with recurrent transient ischemic attacks. Computed topography angiography demonstrated bilateral middle cerebral artery (MCA) stenosis. HR-VWI revealed uniform enhancement and thickening of the arterial wall, suggestive of MCA vasculitis. The patient reported chronic calf rash that was biopsied and revealed unspecified connective tissue disease. With immunomodulation, patient remained asymptomatic and 6-month surveillance HR-VWI showed improved MCA stenoses.Case 2: A 56-year-old male with herpes simplex virus 1 encephalitis was treated with antiviral therapy and improved clinically. Two months later, the brain magnetic resonance imaging revealed new temporo-parietal edema and distal MCA hyperintense vessels. HR-VWI showed MCA concentric smooth contrast enhancement, that was attributed to postinfectious vasculitis and had resolved on follow-up HR-VWI.Case 3: A 41-year-old male presented with 1-week of headache and encephalopathy. Brain magnetic resonance imaging revealed punctate multifocal acute ischemic infarcts and no contrast-enhancement. HR-VWI showed multifocal diffuse enhancement of distal cerebral vasculature. Patient subsequently developed branch retinal artery occlusion and hearing loss and was diagnosed with Susac syndrome. No recurrent symptoms were noted after immunotherapy initiation.
In these 3 cases, HR-VWI identified distinctive vascular inflammatory changes, which were crucial to guide the etiological workup, positive diagnosis, surveillance neuroimaging, and targeted treatment. HR-VWI is an important diagnostic tool in CNS vasculitides, by providing nuanced information about arterial wall integrity and pathology.
我们旨在报告 3 例中枢神经系统（CNS）血管炎病例，其中高分辨率磁共振血管壁成像（HR-VWI）在诊断和治疗中发挥了重要作用。
病例 1：一名 41 岁肥胖、吸烟的女性，患有动脉高血压，表现为反复发作的短暂性脑缺血发作。计算机断层血管造影显示双侧大脑中动脉（MCA）狭窄。HR-VWI 显示动脉壁均匀强化和增厚，提示 MCA 血管炎。患者报告有慢性小腿皮疹，活检显示为未明确的结缔组织疾病。经免疫调节治疗后，患者无症状，6 个月后的 HR-VWI 监测显示 MCA 狭窄改善。病例 2：一名 56 岁男性患有单纯疱疹病毒 1 型脑炎，接受抗病毒治疗后临床症状改善。两个月后，脑部磁共振成像显示新的颞顶叶水肿和 MCA 远端高信号血管。HR-VWI 显示 MCA 同心性光滑对比增强，归因于感染后血管炎，在随访 HR-VWI 上已消退。病例 3：一名 41 岁男性因头痛和脑病发作 1 周就诊。脑部磁共振成像显示点状多灶性急性缺血性梗死，无对比增强。HR-VWI 显示远端脑血管多灶性弥漫性强化。随后患者出现分支视网膜动脉阻塞和听力丧失，被诊断为 Susac 综合征。免疫治疗开始后，无复发症状。
在这 3 例患者中，HR-VWI 识别出了独特的血管炎症性改变，这对于指导病因学检查、明确诊断、监测神经影像学和靶向治疗至关重要。HR-VWI 是 CNS 血管炎的重要诊断工具，通过提供关于动脉壁完整性和病理学的细致信息。
