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Lu P, Cui L, Zhang X. Primary Angiitis of the Central Nervous System in Adults: A Comprehensive Review of 76 Biopsy-Proven Case Reports. J Inflamm Res 2023; 16:5083-5094. [PMID: 37953861 PMCID: PMC10638941 DOI: 10.2147/jir.s434126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose Primary angiitis of the adult central nervous system (PACNS) is an increasingly recognized but limited disease. Using previous case reports, we sought to summarize the clinical symptoms, imaging manifestations, treatment, and prognosis of patients with biopsy-confirmed PACNS to guide clinical diagnosis and management. Methods We searched the Web of Science database for studies published from January 2000 to April 2023, with the language set to English and the document type limited to [Article or Review or Letter or Editorial Material]. A systematic review of all case reports met the inclusion and exclusion criteria was performed. These patients' clinical, pathological, and imaging characteristics were analyzed, and treatment and prognostic data were summarized. Results We analyzed 69 articles, including 76 patients with biopsy-confirmed PACNS. And 57.9% of the patients were male, the median age at presentation was 47.0 years, and focal neurological deficits were the most common symptom in patients (78.9%), followed by headache (52.6%). The median duration of biopsy was 1.1 months, of which 49 (64.5%) patients were lymphocytic, 13 (17.1%) were granulomatous, 11 (14.5%) were amyloidotic, and 3 (3.9%) were necrotizing PACNS. Relapse events occurred in 41 (53.9%) patients, including 34 (44.2%) relapses and 8 (10.5%) deaths. Univariate logistic regression analysis revealed that symptomatic epilepsy, prolonged biopsy time window, and CD20 expression in pathological tissues might be independent risk factors for recurrent events in patients (HR=4.69, 95% CI: 1.51-14.54, p=0.007; HR=1.11, 95% CI: 1.00-1.22, p=0.043; HR=5.33, 95% CI: 1.07-26.61, p=0.041). Conclusion Adult PACNS is associated with frequent relapses and high mortality. Symptomatic epilepsy, prolonged biopsy time window, and CD20 expression in pathological tissue may be associated with recurrent events.
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Affiliation(s)
- Ping Lu
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China
| | - Lingyun Cui
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China
| | - Xinghu Zhang
- Department of Neuroinfection and Neuroimmunology, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China
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Abraham P, Neel I, Bishay S, Sewell DD. Central Nervous System Systemic Lupus Erythematosus (CNS-SLE) Vasculitis Mimicking Lewy Body Dementia: A Case Report Emphasizing the Role of Imaging With an Analysis of 33 Comparable Cases From the Scientific Literature. J Geriatr Psychiatry Neurol 2021; 34:128-141. [PMID: 31996085 DOI: 10.1177/0891988720901788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Neuropsychiatric symptoms occur in 30% to 40% of patients living with systemic lupus erythematosus (SLE). Brain imaging may play a pivotal role in determining the etiology as it did for the case presented here. METHODS A new case of central nervous system (CNS) SLE is presented along with an analysis of 33 comparable cases from the scientific literature. RESULTS A 70-year-old female with subacute cutaneous lupus presented to a university-based geropsychiatry program after 1 year of benign visual hallucinations and several months of shuffling gait, recurrent falls, and forgetfulness. These symptoms were highly suggestive of Lewy body dementia; however, the patient's history of basal ganglia infarct, cognitive testing demonstrating inattention and executive dysfunction, and follow-up brain imaging, which did not reveal acute findings, aligned with cerebral pathology previously attributed to vasculitis and supported the diagnosis of subcortical dementia due to SLE-CNS vasculitis. Oral prednisone 20 mg daily resolved her symptoms. Over the next 19 months, her prednisone was tapered completely and her symptoms did not return. A systematic literature search identified 33 comparable cases. CONCLUSION An analysis of previously published cases suggests that extending the duration of the prednisone taper beyond 1 year may decrease the risk of later occurring neuropsychiatric symptoms in this patient population.
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Affiliation(s)
- Peter Abraham
- Department of Psychiatry, 8784University of California, San Diego, CA, USA
| | - Ian Neel
- Department of Internal Medicine, 8784University of California, San Diego, CA, USA
| | | | - Daniel D Sewell
- Department of Psychiatry, 8784University of California, San Diego, CA, USA
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Suthiphosuwan S, Bharatha A, Hsu CCT, Lin AW, Maloney JA, Munoz DG, Palmer CA, Osborn AG. Tumefactive Primary Central Nervous System Vasculitis: Imaging Findings of a Rare and Underrecognized Neuroinflammatory Disease. AJNR Am J Neuroradiol 2020; 41:2075-2081. [PMID: 32883666 DOI: 10.3174/ajnr.a6736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
Primary central nervous system vasculitis (PCNSV) is a poorly understood neuroinflammatory disease of the CNS affecting the intracranial vasculature. Although PCNSV classically manifests as a multifocal beaded narrowing of the intracranial vessels, some patients may not have angiographic abnormalities. A rare subset of patients with PCNSV present with masslike brain lesions mimicking a neoplasm. In this article, we retrospectively review 10 biopsy-confirmed cases of tumefactive PCNSV (t-PCNSV). All cases of t-PCNSV in our series that underwent CTA or MRA were found to have normal large and medium-sized vessels. T-PCNSV had a variable MR imaging appearance with most cases showing cortical/subcortical enhancing masslike lesion (70%), often with microhemorrhages (80%). Diffusion restriction was absent in all lesions. In summary, normal vascular imaging does not exclude the diagnosis of t-PCNSV. Advanced imaging techniques including MR perfusion and MR spectroscopy failed to demonstrate specific findings for t-PCNSV but assisted in excluding neoplasm in the differential diagnosis. Biopsy remains mandatory for definitive diagnosis.
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Affiliation(s)
- S Suthiphosuwan
- From the Department of Medical Imaging (S.S., A.B., CC-T.H., A.W.L.)
| | - A Bharatha
- From the Department of Medical Imaging (S.S., A.B., CC-T.H., A.W.L.)
- Surgery (A.B.)
| | - C C-T Hsu
- From the Department of Medical Imaging (S.S., A.B., CC-T.H., A.W.L.)
- Department of Medical Imaging (CC-T.H.), Gold Coast University Hospital, Queensland, Australia
| | - A W Lin
- From the Department of Medical Imaging (S.S., A.B., CC-T.H., A.W.L.)
| | - J A Maloney
- Department of Radiology (J.A.M.), University of Colorado, Denver, Colorado
| | - D G Munoz
- Laboratory Medicine and Pathobiology (D.G.M.), University of Toronto, Toronto, Canada
| | | | - A G Osborn
- Radiology and Imaging Sciences (A.G.O.), University of Utah, Salt Lake City, Utah
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Salvarani C, Brown RD, Christianson TJ, Huston J, Morris JM, Giannini C, Hunder GG. Primary central nervous system vasculitis mimicking brain tumor: Comprehensive analysis of 13 cases from a single institutional cohort of 191 cases. J Autoimmun 2019; 97:22-28. [DOI: 10.1016/j.jaut.2018.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/02/2018] [Accepted: 10/08/2018] [Indexed: 12/12/2022]
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Al-Afif S, Hatipoglu Majernik G, Al Krinawe Y, Esmaeilzadeh M, Hartmann C, Krauss JK. The Role of Neurosurgery in the Treatment of Intracranial Tumor-Like Inflammatory Lesions. World Neurosurg 2018; 124:S1878-8750(18)32803-1. [PMID: 30554001 DOI: 10.1016/j.wneu.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Different inflammatory diseases can manifest as intracranial lesions. They may be indistinguishable from intracranial neoplasms in the clinical setting, imaging studies, or laboratory studies. The value of surgery in the diagnosis and the treatment of such lesions is still unclear. METHODS A total of 3066 reports of histopathologic examinations over a 10-year period were reviewed. Forty patients with an inflammatory intracranial lesion were identified. Clinical, radiologic, and follow-up data were analyzed and the diagnostic and therapeutic value of surgery was assessed. RESULTS We identified 24 women and 16 men (mean age, 47 years). The diameter of the lesion varied between 1 and 5.5 cm (mean, 2.6 cm). The location of the inflammatory lesion was intracerebral supratentorial (n = 18, 45%), intrasellar/suprasellar (n = 5, 12.5%), cerebellar (n = 5, 12.5%), in the brainstem (n = 4, 10%), in the cerebellopontine angle (n = 3, 7.5%), meningeal (n = 3, 7.5%), and at other locations (n = 6, 15%). Seventeen patients underwent surgical removal of the mass lesion, whereas in 23 patients a biopsy was taken. The lesions were classified into 7 groups: specific (infectious) granuloma (n = 10, 25%), unspecific granuloma (n = 7, 17.5%), idiopathic inflammatory pseudotumor (n = 5, 12.5%), demyelinating lesions (n = 5, 12.5%) encapsulated hematoma (n = 4, 10%), organized cerebral infarction (n = 3, 7.5%), and vasculitis (n = 4, 10%). Surgery was judged as valuable in 35 patients (87.5%). CONCLUSIONS The differential diagnosis of intracranial inflammatory lesions involves a wide spectrum. Surgery has a diagnostic and/or therapeutic value in most entities and clinical circumstances. However, attention must be taken to avoid surgery without a therapeutic or diagnostic value for the patient.
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Affiliation(s)
- Shadi Al-Afif
- Department of Neurosurgery, Institute for Pathology, Hannover Medical School, Hannover, Germany.
| | | | - Yazeed Al Krinawe
- Department of Neurosurgery, Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Majid Esmaeilzadeh
- Department of Neurosurgery, Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Institute for Pathology, Hannover Medical School, Hannover, Germany
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Renard D, Castelnovo G, Le Floch A, Guillamo JS, Thouvenot E. Pseudotumoral brain lesions: MRI review. Acta Neurol Belg 2017; 117:17-26. [PMID: 27878561 DOI: 10.1007/s13760-016-0725-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
Single or multiple space-occupying lesions on brain MRI, with or without contrast enhancement and/or perilesional oedema, evoke a neoplastic origin. However, a multitude of non-neoplastic disorders can simulate cerebral neoplasia. In this review, we will discuss the MRI characteristics of non-neoplastic disorders that can mimic cerebral neoplasia. Distinguishing MRI characteristics are discussed for each of these non-neoplastic disorders.
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Gan C, Maingard J, Giles L, Phal PM, Tan KM. Primary angiitis of the central nervous system presenting as a mass lesion. J Clin Neurosci 2015; 22:1528-31. [PMID: 26119979 DOI: 10.1016/j.jocn.2015.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
We report a 51-year-old Asian man with primary angiitis of the central nervous system (PACNS) with atypical presentation as a mass lesion. PACNS is an uncommon condition causing inflammation and destruction of the blood vessels of the central nervous system. The aetiology is unclear and multiple mechanisms have been proposed. Its incidence is estimated at 2.4 per million per year, affecting patients of all ages (median 50 years) and more commonly Caucasian men. In Australia, 12 patients fulfilled the diagnostic criteria for PACNS between 1998 and 2009 at The Royal Melbourne Hospital, a university-affiliated tertiary referral centre. The accurate and timely diagnosis of PACNS is very challenging due to disease mimicry and the absence of specific serological tests. This patient illustrates additional diagnostic difficulty with his atypical PACNS presentation as a mass lesion.
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Affiliation(s)
- Calvin Gan
- Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia.
| | - Julian Maingard
- Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia
| | - Lauren Giles
- Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia
| | - Pramit M Phal
- Department of Radiology, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - K Meng Tan
- Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia
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Lyra TG, Martin MDGM, Carvalho RDC, Oliveira CRGCM, Godoy LFDS, Delgado DDS, Cerri GG, Leite CDC. Pseudotumoral presentation of primary central nervous system vasculitis. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:333-5. [PMID: 23689414 DOI: 10.1590/0004-282x20130032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/04/2012] [Indexed: 11/21/2022]
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Bibliography. Genetics. Current world literature. Curr Opin Pediatr 2010; 22:833-5. [PMID: 21610333 DOI: 10.1097/mop.0b013e32834179f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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