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Alzein MM, Patel A, Abdalla RN, Cantrell DR, Shaibani A, Ansari SA. MR Vessel Wall Imaging for Atherosclerosis and Vasculitis. Neuroimaging Clin N Am 2024; 34:251-260. [PMID: 38604709 DOI: 10.1016/j.nic.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Conventional imaging modalities, such as computed tomography angiography, MR angiography, transcranial Doppler ultrasonography, and digital subtraction angiography, are utilized in evaluating intraluminal or intravascular pathology of the intracranial vessels. Limitations of luminal imaging techniques can lead to inaccurate diagnosis, evaluation, and risk stratification, as many cerebrovascular pathologies contain an extrinsic vessel wall component. Furthermore, vessel wall imaging can provide information regarding extent, treatment response, and biopsy targets for vasculitis cases. Overall, while vessel wall imaging can provide robust data regarding intracranial pathologies, further prospective, multicenter studies are required to improve diagnostic application and accuracy.
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Affiliation(s)
- Mohamad M Alzein
- Department of Radiology, Northwestern University, Feinberg School of Medicine
| | - Abhinav Patel
- Department of Radiology, Northwestern University, Feinberg School of Medicine
| | - Ramez N Abdalla
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Radiology, Ain Shams University, Faculty of Medicine
| | - Donald R Cantrell
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital
| | - Ali Shaibani
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine
| | - Sameer A Ansari
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine; Department of Neurology, Northwestern University, Feinberg School of Medicine.
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Tian Z, Wu X, Zhang B, Li W, Wang C. Transcription factor CEBPB mediates intracranial aneurysm rupture by inflammatory and immune response. CNS Neurosci Ther 2024; 30:e14603. [PMID: 38332649 PMCID: PMC10853640 DOI: 10.1111/cns.14603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Genetic factors play a major part in mediating intracranial aneurysm (IA) rupture. However, research on the role of transcription factors (TFs) in IA rupture is rare. AIMS Bioinformatics analysis was performed to explore the TFs and related functional pathways involved in IA rupture. RESULTS A total of 63 differentially expressed transcription factors (DETFs) were obtained. Significantly enriched biological processes of these DETFs were related to regulation of myeloid leukocyte differentiation. The top 10 DETFs were screened based on the MCC algorithm from the protein-protein interaction network. After screening and validation, it was finally determined that CEBPB may be the hub gene for aneurysm rupture. The GSEA results of CEBPB were mainly associated with the inflammatory response, which was also verified by the experimental model of cellular inflammation in vitro. CONCLUSION The inflammatory and immune response may be closely associated with aneurysm rupture. CEBPB may be the hub gene for aneurysm rupture and may have diagnostic value. Therefore, CEBPB may serve as the diagnostic signature for RIAs and a potential target for intervention.
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Affiliation(s)
- Zhongbin Tian
- Department of Interventional Radiology, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Xuefang Wu
- Department of OncologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Baorui Zhang
- Department of Neurosurgery, Beijing Tongren HospitalCapital Medial UniversityBeijingChina
| | - Wei Li
- Department of OncologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Chao Wang
- Department of Neurointerventional SurgeryBinzhou Medical University HospitalBinzhouChina
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Amin M, Uchino K, Hajj-Ali RA. Central Nervous System Vasculitis: Primary Angiitis of the Central Nervous System and Central Nervous System Manifestations of Systemic Vasculitis. Rheum Dis Clin North Am 2023; 49:603-616. [PMID: 37331735 DOI: 10.1016/j.rdc.2023.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Central nervous system vasculitis (CNSV) is a group of disorders leading to inflammatory vasculopathy within the brain, spinal cord, and leptomeninges. CNSV is divided into primary angiitis of the central nervous system (PACNS) and secondary CNSV based on the underlying etiology. PACNS is a rare inflammatory disorder with poorly understood pathophysiology and heterogeneous and highly variable clinical features. The diagnosis depends on a combination of clinical and laboratory variables, multimodal imaging, and histopathological examination as well as exclusion of mimics. Several systemic vasculitides, infectious etiologies and connective tissue disorders have been shown to cause secondary CNSV and require prompt recognition.
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Affiliation(s)
- Moein Amin
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ken Uchino
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
| | - Rula A Hajj-Ali
- Cleveland Clinic Center for Vasculitis Care and Research, Cleveland Clinic, 9500 Euclid Avenue, A50, Cleveland, OH 44195, USA.
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Corrêa DG, Pacheco FT, da Cruz LCH, Nunes RH, Maia ACM, de Souza Godoy LF, Bisolo L, da Silva NA, Soldatelli MD, de Siqueira Campos CM, Vedolin LM, do Amaral LLF, da Rocha AJ. Intracranial vessel wall magnetic resonance imaging features of infectious vasculitis. Clin Imaging 2023; 98:26-35. [PMID: 36996597 DOI: 10.1016/j.clinimag.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/19/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
Vasculitis is a complication of several infectious diseases affecting the central nervous system, which may result in ischemic and/or hemorrhagic stroke, transient ischemic attack, and aneurysm formation. The infectious agent may directly infect the endothelium, causing vasculitis, or indirectly affect the vessel wall through an immunological mechanism. The clinical manifestations of these complications usually overlap with those of non-infectious vascular diseases, making diagnosis challenging. Intracranial vessel wall magnetic resonance imaging (VWI) enables the evaluation of the vessel wall and the diseases that affect it, providing diagnostic data beyond luminal changes and enabling the identification of inflammatory changes in cerebral vasculitis. This technique demonstrates concentric vessel wall thickening and gadolinium enhancement, associated or not with adjacent brain parenchymal enhancement, in patients with vasculitis of any origin. It permits the detection of early alterations, even before a stenosis occurs. In this article, we review the intracranial vessel wall imaging features of infectious vasculitis of bacterial, viral, and fungal etiologies.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil; Department of Radiology, Federal Fluminense University, Niterói, RJ, Brazil.
| | - Felipe Torres Pacheco
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | | | - Renato Hoffmann Nunes
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Antônio Carlos Martins Maia
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, Fleury, São Paulo, SP, Brazil
| | | | - Louise Bisolo
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Nivaldo Adolfo da Silva
- Department of Radiology, DASA, São Paulo, SP, Brazil; Department of Radiology, University of Campinas, Campinas, SP, Brazil
| | | | | | - Leonardo Modesti Vedolin
- Department of Radiology, DASA, São Paulo, SP, Brazil; Department of Radiology, Hospital de Clínicas de Porta Alegre, Porto Alegre, RS, Brazil
| | | | - Antônio José da Rocha
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
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Das S, Ray BK, Mishra L, Chatterjee K, Mondal G, Paul DK. The Spectrum of Pediatric Infection-Associated Intracranial Arteriopathies and Acute Ischemic Stroke at 2 Eastern Indian Tertiary Care Centres. J Child Neurol 2023; 38:422-434. [PMID: 37138497 DOI: 10.1177/08830738231171800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Major and minor pediatric infections may cause intracranial arteriopathies, the long-term outcome of which we investigated and identified the factors influencing the progression/resolution of arteriopathies. METHODS We collected the clinical and radiological data of children aged 1 month-15 years who had ischemic stroke with definite arteriopathy following a recent febrile infection. Repeated neuroimaging was done over the next year to ascertain recurrent strokes and the progression and resolution of arteriopathies. RESULTS The anterior circulation was more frequently affected (83.33%), predominantly involving the middle cerebral artery (41.67%), resolving in 20.84% of cases and progressing in 33.33% of cases. Lesions were commonly unilateral (54.17%) and stenotic (75%), resulting predominantly in cortical infarcts (45.83%), with hemiparesis being the most common neurodeficiency. Apart from tubercular meningitis patients, others had a good functional outcome. CONCLUSION Lower age, minor infections, and unilateral arteriopathies had a significantly higher chance of resolution. Postviral arteriopathies had a significantly lower chance of progression compared with those following bacterial infections. Progressive and bilateral arteriopathies were significantly associated with worse outcomes and recurrent strokes.
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Affiliation(s)
- Suman Das
- Department of Neurology, North Bengal Medical College, Shusrutnagar, Darjeeling, West Bengal, India
| | - Biman Kanti Ray
- Department of Neurology, Bangur Institute of Neurology, Kolkata, West Bengal, India
| | | | - Kaushani Chatterjee
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Gobinda Mondal
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Dilip Kumar Paul
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
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Lötscher F, Pop R, Seitz P, Recher M, Seitz L. Spectrum of Large- and Medium-Vessel Vasculitis in Adults: Neoplastic, Infectious, Drug-Induced, Autoinflammatory, and Primary Immunodeficiency Diseases. Curr Rheumatol Rep 2022; 24:293-309. [PMID: 35920952 PMCID: PMC9362566 DOI: 10.1007/s11926-022-01083-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 02/06/2023]
Abstract
Purpose of Review To provide a comprehensive review of drugs and neoplastic, infectious, autoinflammatory, and immunodeficiency diseases causing medium- to large-vessel vasculitis in adults with emphasis on information essential for the initial diagnostic process. Recent Findings Entities with medium- to large-vessel vasculitis as clinical manifestations have been described recently (e.g., adenosine deaminase-2 deficiency, VEXAS-Syndrome), and vasculitis in established autoinflammatory or immunodeficiency diseases is increasingly being identified. Summary In the diagnostic process of medium- to large-vessel vasculitis in adults, a large variety of rare diseases should be included in the differential diagnosis, especially if diagnosis is made without histologic confirmation and in younger patients. Although these disorders should be considered, they will undoubtedly remain rare in daily practice. Supplementary Information The online version contains supplementary material available at 10.1007/s11926-022-01083-5.
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Affiliation(s)
- Fabian Lötscher
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Roxana Pop
- Department of Infectious Diseases and Hospital Hygiene, University Hospital, University of Zurich, Zurich, Switzerland
| | - Pascal Seitz
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Mike Recher
- Immunodeficiency Laboratory, Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland.,University Center for Immunology, University Hospital, Basel, Switzerland
| | - Luca Seitz
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. .,Immunodeficiency Laboratory, Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland.
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Huang M, Li ZX, Chen J, Chen L, Li YY. Extracts of Bauhinia Championii Alleviate Acute Neuronal Injury After Ischemic Reperfusion by Improving Endoplasmic Reticulum Stress-Mediated Neuronal Apoptosis. Curr Med Sci 2022; 42:483-490. [DOI: 10.1007/s11596-022-2525-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/12/2021] [Indexed: 11/03/2022]
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High-resolution intracranial vessel wall imaging in cerebral viral infections evaluations. Neuroradiology 2021; 64:915-924. [PMID: 34657167 PMCID: PMC8520459 DOI: 10.1007/s00234-021-02831-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
Purpose Vascular complications can be seen in various viral CNS infections. Variable neuro-imaging findings have been described in the literature elucidating the parenchymal changes with vascular involvement. Vessel wall imaging (VWI) can help to detect these vascular involvements. We aimed to describe the role and usefulness of VWI in the evaluation of various viral CNS infections. Methods In this prospective study, we included 15 cases of various diagnosed viral CNS infections (varicella, HIV encephalopathy, HSV encephalitis, Japanese encephalitis, dengue, COVID-19). VWI and time-of-flight MR angiography (TOF MRA) were included in imaging protocol. All cases were evaluated for the presence of cerebral parenchymal changes, vascular enhancement, and vascular stenosis. Results We found infarctions in all 5 cases of varicella, 1 case of HIV encephalopathy, and 1 case of COVID-19 encephalopathy. All these cases also showed vascular enhancement and stenosis on VWI. The rest of the cases, including 1 case of HIV encephalopathy, 3 cases of herpes encephalitis, 2 cases of dengue, and 2 cases of Japanese encephalitis did not have any vascular complication, and also did not show vascular enhancement or stenosis. Conclusion VWI can be useful in the detection of vascular involvement in various viral infections of CNS which show a relatively higher cerebrovascular complication rate like varicella, HIV encephalopathy, and COVID-19. However, VWI may not be useful in the routine evaluation of other viral infections like herpes, dengue, and Japanese encephalitis, which have a very low rate of cerebrovascular complication rate.
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