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Abstract
With 16.9 million people who suffered a first-ever stroke in 2010 worldwide, stroke is a very common vascular disease. Epidemiologic studies have played an essential role in assessing this burden and in detecting the risk factors for stroke. Primary prevention of these risk factors, primarily hypertension, smoking, diabetes, and atrial fibrillation, has reduced the incidence in high-income countries. However, stroke remains a major cause of death and disability, and therefore research should be continued. Subarachnoid hemorrhages are less prevalent than strokes but have an even higher risk of death. Similar to stroke, epidemiologic studies identified smoking and hypertension as its most important risk factors, together with excessive alcohol intake. Although rare, arterial dissections, CADASIL, arteriovenous malformations, venous sinus thrombosis, moyamoya disease, and vasculitis can lead to serious symptoms. The burden and risk factors of those rare diseases are more challenging to assess. Whenever possible, they should be recognized in a timely manner for their increased risk of stroke, but most often they are diagnosed only at the time of stroke. Some cerebrovascular abnormalities do not result in immediate symptoms. This subclinical cerebrovascular disease includes silent infarcts, white-matter lesions, and microbleeds, and is incidentally found by neuroimaging. These lesions are not innocent, as several epidemiologic studies have associated subclinical cerebrovascular disease with an increased risk of stroke, cognitive decline, dementia, and death.
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Affiliation(s)
- M L P Portegies
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - P J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M A Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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2
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Abstract
The noninfectious, inflammatory vasculitides include giant cell arteritis, Takayasu disease, Churg-Strauss angiitis, Wegener disease, polyarteritis nodosa, microscopic polyangiitis, Buerger disease, amyloid-β-related angiitis, and isolated vasculitis of the central nervous system. While these disorders are relatively uncommon, they produce a variety of neurologic diseases including muscle disease, mononeuropathy multiplex, polyneuropathy, cranial nerve palsies, visual loss, seizures, an encephalopathy, venous thrombosis, ischemic stroke, and intracranial hemorrhage. The multisystem vasculitides often have stereotypical clinical findings that reflect disease of the kidney, sinuses, lungs, skin, joints, or cardiovascular system. These disorders also usually have abnormalities found on serologic testing. Isolated vasculitis of the central nervous system is more difficult to diagnose because the clinical and brain imaging findings are relatively nonspecific. Examination of the cerebrospinal fluid will demonstrate changes consistent with an inflammatory process. Arteriography often shows areas of segmental narrowing affecting multiple intracranial vessels and brain/meningeal biopsy may be required to establish the diagnosis. Management of patients with a multisystem vasculitis or isolated vasculitis of the central nervous system is centered on the administration of immunosuppressive agents. In many cases, corticosteroids remain the mainstay of medical treatment.
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Affiliation(s)
- Harold P Adams
- Division of Cerebrovascular Diseases, Department of Neurology, Carver College of Medicine, University of Iowa Health Care Stroke Center, University of Iowa, Iowa City, IA, USA.
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3
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de Boysson H, Faivre A, Pagnoux C. Vascularites cérébrales. Presse Med 2012; 41:1071-83. [DOI: 10.1016/j.lpm.2011.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/14/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022] Open
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4
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Abstract
Vascular dementia is a common cause of late-life cognitive decline. Vascular risk factors, transient ischemic attacks, silent and clinically evident strokes, and ischemic changes on brain imaging studies are all associated with the development of dementia. Prevention of vascular dementia involves treatment of risk factors and the same preventive measures used to avoid heart attacks and strokes. Other treatments for vascular dementia, although promising, remain unproved.
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5
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Abstract
We report a patient with linear scleroderma en coup de sabre without neurological symptoms despite the presence of large white matter lesions. The patient underwent 3.0-T magnetic resonance (MR) examinations including diffusion tensor imaging, time-resolved contrast-enhanced MR angiography, susceptibility-weighted imaging, and proton MR spectroscopy. These imaging findings suggested increased vascular permeability and microbleeding without abnormalities of metabolites. Our observation is consistent with vasculopathy and may be helpful in the proper diagnosis and treatment of linear scleroderma en coup de sabre.
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Di Leo E, Dambra PP, Capuzzimati L, Giovine A, Guerriero S, Nettis E, Vacca A. A case of Cogan's syndrome resolved with mycophenolate sodium. Eur J Clin Invest 2008; 38:605. [PMID: 18717829 DOI: 10.1111/j.1365-2362.2008.01983.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Cho BS, Kim HS, Oh SJ, Ko HJ, Yoon CH, Jung SL, Min DJ, Kim WU. Comparison of the clinical manifestations, brain MRI and prognosis between neuroBeçhet's disease and neuropsychiatric lupus. Korean J Intern Med 2007; 22:77-86. [PMID: 17616022 PMCID: PMC2687621 DOI: 10.3904/kjim.2007.22.2.77] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Neuropsychiatric systemic lupus erythematosus (NPSLE) shows some similarities to neuroBeçhet disease (NBD) in that both conditions have some analogous clinical features and they are both pathologically associated cerebral vasculopathy. This study compared the clinical manifestations, brain MRI findings and prognosis of NPSLE and NBD patients. METHODS Forty three patients with NPSLE (n = 25) or NBD (n = 18), who were monitored at a single center, were enrolled in this study. We retrospectively analyzed the clinical and brain MRI data. The neuropsychiatric manifestations were classified in both groups according to the new American College of Rheumatology nomenclature for NPSLE. RESULTS The diffuse symptoms that included mood disorders, psychosis, confusion, cognitive dysfunctions, generalized seizures and headaches other than migraine or cluster headaches were more commonly observed in the NPSLE patients, while the frequency of focal diseases such as cranial neuropathy tended to be higher in the NBD patients. The brain MRI revealed that the NBD patients had more abnormalities in the brain stem than did the NPSLE patients. Most of the patients improved, at least partially, after being treated with glucocorticoid and/or immune suppressants. However, the disease course differed significantly between the two groups. There were more episodic cases in the NPSLE group of patients, while there were more remittent cases in the NBD group of patients. CONCLUSION NPSLE had a tendency to cause diffuse neuropsychiatric manifestations, and it has a different predilection of brain lesions compared with NBD. The NBD patients showed a poorer outcome than did the NPSLE patients, suggesting that different therapeutic strategies for the two diseases need to be considered.
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Affiliation(s)
- Byung-Sik Cho
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Hyun-Sook Kim
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Su-Jin Oh
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Hyeok-Jae Ko
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Chong-Hyun Yoon
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - So-Lyung Jung
- Department of Radiology, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Do-June Min
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Wan-Uk Kim
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
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8
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Gapon MV, Dranitsyna SM, Minkevich NI, Gruden' MA, Babichenko II, Kostanyan IA. Experimental model of hemorrhagic stroke: Rabbit immunization with HL-60 promyelocytic cell differentiation factor. Bull Exp Biol Med 2006; 141:272-4. [PMID: 16984116 DOI: 10.1007/s10517-006-0147-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Rabbits immunized with synthetic HLDF differentiation factor developed hemorrhagic stroke with thrombosis of small cerebral vessels and destruction of vascular endotheliocytes. The severity of stroke correlated with serum level of antibodies to differentiation factor. The role of different sites of HLDF molecule in the induction of clinical signs of hemorrhagic stroke was studied.
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Affiliation(s)
- M V Gapon
- Laboratory of Hormonal Regulation Proteins, M M Shemyakin and Yu A Ovchinnikov Institute of Organic Biochemistry, Russian Academy of Sciences
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9
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Hocaoglu C, Tan M. Isolated angiitis of the central nervous system: a case presented with atypical psychiatric symptoms. Prog Neuropsychopharmacol Biol Psychiatry 2005; 29:627-31. [PMID: 15866368 DOI: 10.1016/j.pnpbp.2005.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
Abstract
Isolated angiitis of the central nervous system (IACNS) is a rare form of angiitis limited to the central nervous system. The clinical finding of the combined series revealed that headache was the most common symptom within a combination of focal and diffuse neurological deficits. The case, a 28-year-old man, is presented; the clinical presentation and diagnostic difficulties are discussed. The patient's symptoms began with an obvious atypical depression. In spite of an antidepressive treatment, his symptoms continued to worsen with personality, mood changes and euphoria added to the clinical picture. Meanwhile after several transient ischemic attacks, 6 months later, he was admitted with neurological symptoms including headache, diplopia, and cerebellar ataxia. The radiological investigation was mimicked by primary brain lymphoma. The brain biopsy excluding of lymphoma revealed parenchymal hemorrhage with nonspecific degenerative changes. In systemic investigation, no underlying cause for vasculitis could be found. Neurological but not psychological deficits and radiological lesions of the patient improved with steroid therapy. Since we could not find features of systemic vasculitis, the patient's lesions responded to corticosteroid treatment and neuropathological investigation revealed no lymphoma, We concluded that the most probable diagnosis would be IACNS.
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Affiliation(s)
- Cicek Hocaoglu
- Department of Psychiatry, Karadeniz Technical University Medical School, Trabzon, Turkey.
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10
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Tamargo RJ, Connolly ES, McKhann GM, Khandji A, Chang Y, Libien J, Adams D. Clinicopathological review: primary angiitis of the central nervous system in association with cerebral amyloid angiopathy. Neurosurgery 2003; 53:136-43; discussion 143. [PMID: 12823882 DOI: 10.1227/01.neu.0000068864.20655.31] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2002] [Accepted: 02/12/2003] [Indexed: 11/19/2022] Open
Affiliation(s)
- Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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11
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Affiliation(s)
- Vesna V Brinar
- Department of Neurology, Faculty of Medicine, University of Zagreb, and REBRO Hospital Center, Kispaticeva 12, 10,000 Zagreb, Croatia.
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12
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Keay SD, Carroll SGM, Scrutton M, Kelly A, Ormerod I, Cahill DJ. Homonymous hemianopia following a triplet pregnancy: post-natal cerebral vasculitis or atypical eclampsia. Eur J Obstet Gynecol Reprod Biol 2002; 103:92-4. [PMID: 12039474 DOI: 10.1016/s0301-2115(02)00008-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 46-year-old woman with a triplet pregnancy developed seizures, an oculogyric crisis and a homonymous hemianopia post-natally. Abnormal neuroimaging studies and lumbar puncture suggested possible cerebral vasculitis. Treatment with aciclovir and prednisolone resulted in a slow resolution of symptoms. This case highlights the difficulty in distinguishing eclampsia from rarer neurological causes of peripartum seizures.
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Affiliation(s)
- Stephen D Keay
- Departments of Obstetrics and Gynaecology, St. Michael's Hospital, Southwell St., Bristol BS2 8EG, UK
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Rovaris M, Pedroso C, Filippi M. Neuroimaging techniques in the diagnostic work-up of patients with the antiphospholipid syndrome. Curr Rheumatol Rep 2001; 3:301-6. [PMID: 11470048 DOI: 10.1007/s11926-001-0034-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The detection of multisystemic involvement often leads to a correct diagnosis of the antiphospholipid syndrome (APS), even in cases with predominant neurologic manifestations. However, when central nervous system deficits are isolated and have a relapsing-remitting or a progressive course, other conditions must be carefully considered. In this context, the diagnostic accuracy of conventional magnetic resonance imaging (MRI) is hampered by its limited pathologic specificity, which is one of the reasons why no or only modest correlations have been found between the burden of MRI-visible lesions and other clinical or laboratory measures of disease severity in patients with APS. Neuroimaging techniques with a higher pathologic specificity than conventional MRI show promise in achieving diagnostic confidence earlier in the course of APS and in better monitoring the efficacy of therapeutic interventions.
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Affiliation(s)
- M Rovaris
- Neuroimaging Research Unit, Department of Neuroscience, Scientific Institute and University H San Raffaele, via Olgettina 60, 20132, Milan, Italy.
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14
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Perez VL, Foster CS. Uveitis with neurological manifestations. Int Ophthalmol Clin 2001; 41:41-59. [PMID: 11198146 DOI: 10.1097/00004397-200101000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neurological symptoms are not rare in patients with various uveitic syndromes, and they can be used as a guide to diagnosis. Some of the findings are nonspecific, but others can be typical of certain pathological conditions (table). After combining the information obtained in the medical history with the physical examination, target-oriented laboratory and diagnostic tests may then be obtained to confirm a diagnosis. Neurological manifestations can be of great value throughout this process and clearly should be carefully evaluated in every patient with uveitis.
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Affiliation(s)
- V L Perez
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Rovaris M, Viti B, Ciboddo G, Capra R, Filippi M. Cervical cord magnetic resonance imaging findings in systemic immune-mediated diseases. J Neurol Sci 2000; 176:128-30. [PMID: 10930595 DOI: 10.1016/s0022-510x(00)00325-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Brain magnetic resonance imaging (MRI) findings in patients with systemic immune-mediated diseases (SID) affecting the central nervous system (CNS) are heterogeneous and lack diagnostic specificity. In the present study, we evaluated the potential role of cervical cord MRI for increasing confidence when making a diagnosis of SID. Sagittal, T2-weighted images of the cervical cord were obtained in patients affected by systemic lupus erythematosus (SLE) with (NSLE, n=9) and without clinical CNS involvement (n=15), Behçet disease (BD, n=5), Wegener granulomatosis (WG, n=9), antiphospholipid antibody syndrome (APLAS, n=6) and multiple sclerosis (MS, n=10). Spinal cord hyperintense lesions were found in 9/10 MS patients, while no lesions were visible in the cervical cord of any patient with SID, regardless of the presence or absence of brain abnormalities. Cervical cord MRI can be useful in diagnosing patients suspected of having a SID.
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Affiliation(s)
- M Rovaris
- Neuroimaging Research Unit, Department of Neuroscience, Scientific Institute Ospedale San Raffaele, via Olgettina 60, 20132, Milan, Italy
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Rovaris M, Viti B, Ciboddo G, Gerevini S, Capra R, Iannucci G, Comi G, Filippi M. Brain involvement in systemic immune mediated diseases: magnetic resonance and magnetisation transfer imaging study. J Neurol Neurosurg Psychiatry 2000; 68:170-7. [PMID: 10644783 PMCID: PMC1736780 DOI: 10.1136/jnnp.68.2.170] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Magnetisation transfer imaging (MTI) provides information about brain damage with increased pathological specificity over conventional MRI and detects subtle abnormalities in the normal appearing brain tissue, which go undetected with conventional scanning. Brain MRI and MTI findings were compared in patients with multiple sclerosis (MS) and systemic immune mediated diseases (SIDs) affecting the CNS to investigate their roles in understanding the nature of brain damage in these diseases. METHODS Brain dual echo, T1 weighted and MTI scans were obtained in patients affected by systemic lupus erithematosus (SLE) with (NSLE, n=9) and without clinical CNS involvement (n=15), Behçet's disease (BD) (n=5), Wegener's granulomatosis (WG) (n=9), and antiphospholipid antibody syndrome (APLAS) (n=6). Ten patients with clinically definite MS and 15 healthy controls also underwent the same scanning protocol. Brain MRI and MT ratio (MTR) images of the same subject were coregistered and postprocessed to obtain MTR histograms of the whole brain and of the NABT. RESULTS Brain hyperintense lesions were found in all patients with MS and with NSLE and in 5/15 patients with SLE, 5/9 with WG, 1/5 with BD, and 3/6 with APLAS. The lesion burden in the brain was significantly higher in patients with MS compared with all the other disease groups. All MTR histogram parameters were significantly different among patient subgroups. Patients with MS had significantly lower average MTR than all except patients with NSLE and significantly lower peak height and location than patients with SLE. patients with NSLE had significantly lower average MTR than patients with SLE. CONCLUSIONS Microscopic brain tissue damage is relevant in patients with MS, but, apart from patients with NSLE, it seems to be absent in systemic immune mediated diseases, even in the presence of macroscopic MRI lesions or clinical evidence of CNS involvement.
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Affiliation(s)
- M Rovaris
- Neuroimaging Research Unit, Department of Neuroscience, Hopital San Raffaele, Milan, Italy
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Kanzato N, Matsuzaki T, Komine Y, Saito M, Saito A, Yoshio T, Suehara M. Localized scleroderma associated with progressing ischemic stroke. J Neurol Sci 1999; 163:86-9. [PMID: 10223417 DOI: 10.1016/s0022-510x(98)00267-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We present a 73 year-old Japanese woman with localized scleroderma involving the right side of the scalp accompanied by continuous tingling pain, who developed insidiously progressive left hemiparesis. In magnetic resonance imaging of the brain, an infarct first appeared in the watershed region of the right middle cerebral artery territory and subsequently extended to deep white matter accompanied by scattered hemorrhages. Focal stenosis in the M2 portion of the right middle cerebral artery was revealed on magnetic resonance angiography, and the distal vessels were only shown faintly. A biopsy specimen from the sclerotic scalp lesion showed obvious thickening of vessel walls and mild mononuclear cell infiltration. We believe that the progressing ischemic stroke was caused by hemodynamic disturbances from localized sclerotic obstruction of the middle cerebral artery, with an autoimmune pathogenesis.
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Affiliation(s)
- N Kanzato
- Department of Neurology, National Okinawa Hospital, Japan
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