51
|
Edgell RC, Sarhan AE, Soomro J, Einertson C, Kemp J, Shirani P, Malmstrom TK, Coppens J. The Role of Catheter Angiography in the Diagnosis of Central Nervous System Vasculitis. INTERVENTIONAL NEUROLOGY 2016; 5:194-208. [PMID: 27781050 DOI: 10.1159/000445255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Central nervous system vasculitis (CNSV) is a rare disorder, the pathophysiology of which is not fully understood. It involves a combination of inflammation and thrombosis. CNSV is most commonly associated with headache, gradual changes in mental status, and focal neurological symptoms. Diagnosis requires the effective use of history, laboratory testing, imaging, and biopsy. Catheter angiography can be a powerful tool in the diagnosis when common and low-frequency angiographic manifestations of CNSV are considered. We review these manifestations and their place in the diagnostic algorithm of CNSV. SUMMARY We reviewed the PubMed database for case series of CNSV that included 5 or more patients. Demographic and angiographic findings were collected. Angiographic findings were dichotomized between common and low-frequency findings. A system for incorporating these findings into clinical decision-making is proposed. KEY MESSAGE CNSV is a diagnostic challenge due to the absence of a true gold standard test. In the absence of such a test, catheter angiography remains a central piece of the diagnostic puzzle when appropriately employed and interpreted.
Collapse
Affiliation(s)
- Randall C Edgell
- Department of Neurology, Saint Louis University, Saint Louis, Mo, USA
| | - Ahmed E Sarhan
- Department of Neurology, Saint Louis University, Saint Louis, Mo, USA
| | - Jazba Soomro
- Department of Neurology, Saint Louis University, Saint Louis, Mo, USA
| | | | - Joanna Kemp
- Department of Neurosurgery, Saint Louis University, Saint Louis, Mo, USA
| | - Peyman Shirani
- Department of Neurology, Saint Louis University, Saint Louis, Mo, USA
| | - Theodore K Malmstrom
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, Saint Louis, Mo, USA
| | - Jeroen Coppens
- Department of Neurosurgery, Saint Louis University, Saint Louis, Mo, USA
| |
Collapse
|
53
|
Thom V, Schmid S, Gelderblom M, Hackbusch R, Kolster M, Schuster S, Thomalla G, Keminer O, Pleß O, Bernreuther C, Glatzel M, Wegscheider K, Gerloff C, Magnus T, Tolosa E. IL-17 production by CSF lymphocytes as a biomarker for cerebral vasculitis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e214. [PMID: 27144213 PMCID: PMC4841502 DOI: 10.1212/nxi.0000000000000214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 01/13/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore the possibility of using interleukin-17 (IL-17) production by CD4+ T cells in the CSF as a potential biomarker for cerebral vasculitis in stroke patients. METHODS In this consecutive case study, we performed prospective analysis of CSF and blood in patients admitted to a university medical center with symptoms of stroke and suspected cerebral vasculitis. Flow cytometry was performed for intracellular detection of inflammatory cytokines in peripheral blood lymphocytes and expanded T cells from CSF. RESULTS CSF CD4+ lymphocytes from patients with cerebral vasculitis showed significantly higher levels of the proinflammatory cytokine IL-17 compared to patients with stroke not due to vasculitis or with other, noninflammatory neurologic diseases. There was no difference in the production of interferon-γ in the CSF and no overall differences in the relative frequencies of peripheral immune cells. CONCLUSIONS Intracellular IL-17 in CSF cells is potentially useful in discriminating cerebral vasculitis as a rare cause in patients presenting with ischemic stroke. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that an increased proportion of IL-17-producing CD4+ cells in CSF of patients presenting with stroke symptoms is indicative of cerebral vasculitis (sensitivity 73%, 95% confidence interval [CI] 39-94%; specificity 100%, 95% CI 74%-100%).
Collapse
Affiliation(s)
- Vivien Thom
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Sabrina Schmid
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Mathias Gelderblom
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Romy Hackbusch
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Manuela Kolster
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Simon Schuster
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Götz Thomalla
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Oliver Keminer
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Ole Pleß
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Christian Bernreuther
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Markus Glatzel
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Karl Wegscheider
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Christian Gerloff
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Tim Magnus
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| | - Eva Tolosa
- Departments of Immunology (V.T., R.H., M.K., E.T.), Neurology (V.T., S.S., M.G., S.S., G.T., C.G., T.M.), Neuropathology (C.B., M.G.), and Medical Biometry and Epidemiology (K.W.), University Medical Center Hamburg-Eppendorf; and IME Screening Port (O.K., O.P.), Fraunhofer Institute for Molecular Biology and Applied Ecology, Hamburg, Germany
| |
Collapse
|