1
|
Yang L, Zheng Z, Zeng Y, Zhang S, Jin P, Li Y, Li J, Tang R. A case of unexpected death due to primary angiitis of the central nervous system. Forensic Sci Med Pathol 2024; 20:675-680. [PMID: 37126199 DOI: 10.1007/s12024-023-00631-4] [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] [Accepted: 04/08/2023] [Indexed: 05/02/2023]
Abstract
Primary angiitis of the central nervous system (PACNS) is a rare and fatal cerebral vasculitis mainly involving the arteriole of the pia mater, cerebral cortex, and spinal cord. It has an insidious onset atypical symptoms. In this paper, we reported an unexpected death due to cerebral hemorrhage caused by PACNS. According to the typical clinical manifestations (headache, dizziness, weakness of the limbs, temporary blurred vision, etc.) and pathological examination (wide degeneration and fibrinoid necrosis of blood vessel walls with inflammatory cell infiltration), as well as hematoxylin-eosin staining, immunohistochemistry for CD15 + and gram staining, we finally determined that the patient died due to cerebral vascular rupture and hemorrhage caused by PACNS. This case illustrates the value and key points of autopsy in evaluating sudden deaths.
Collapse
Affiliation(s)
- Li Yang
- Department of Forensic Medicine, College of Basic Medicine, Chongqing Medical University, Yuzhong District, 1 Medical College Road, Chongqing, 400010, China
| | - Zhe Zheng
- Department of Forensic Medicine, Henan University of Science and Technology, Luoyang, 471023, Henan, China
| | - Yujie Zeng
- Department of Forensic Medicine, College of Basic Medicine, Chongqing Medical University, Yuzhong District, 1 Medical College Road, Chongqing, 400010, China
| | - Shangyu Zhang
- Department of Forensic Medicine, College of Basic Medicine, Chongqing Medical University, Yuzhong District, 1 Medical College Road, Chongqing, 400010, China
| | - Pengyue Jin
- Department of Forensic Medicine, College of Basic Medicine, Chongqing Medical University, Yuzhong District, 1 Medical College Road, Chongqing, 400010, China
| | - Yongguo Li
- Department of Forensic Medicine, College of Basic Medicine, Chongqing Medical University, Yuzhong District, 1 Medical College Road, Chongqing, 400010, China
| | - Jianbo Li
- Department of Forensic Medicine, College of Basic Medicine, Chongqing Medical University, Yuzhong District, 1 Medical College Road, Chongqing, 400010, China.
| | - Renkuan Tang
- Department of Forensic Medicine, College of Basic Medicine, Chongqing Medical University, Yuzhong District, 1 Medical College Road, Chongqing, 400010, China.
| |
Collapse
|
2
|
Kalashnikova LA, Anufriev PL, Konovalov RN, Dobrynina LA, Shabalina AA. [Pseudotumorous form of primary central nervous system vasculitis]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:141-147. [PMID: 38147394 DOI: 10.17116/jnevro2023123121141] [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: 12/27/2023]
Abstract
A 23-year-old female patient with primary vasculitis of the central nervous system simulating a brain tumor is described. The clinical picture was represented by migraine-like headaches, ataxia, transient numbness of the right leg, the lips, double vision, a slight decrease of cognitive functions. MRI of the brain revealed a tumor-like focus in the cerebellum, intensively accumulating contrast, containing micro-hemorrhages (SWI mode). Small single ischemic foci in the brain hemispheres and brain stem were also found. MR angiography (3T) did not found any pathology. Examination of the cerebrospinal fluid revealed a small cytosis (mainly T-lymphocytes) and a slight increase in protein. The results of the analysis of cerebrospinal fluid for syphilis, tuberculosis and the herpetic group of viruses were negative, type 1 oligoclonal synthesis was found. Blood tests for toxoplasmosis, antibodies to aquaporin, anti-neutrophil antibodies, markers of systemic inflammation were within normal limits. Different diagnoses were assumed: demyelinating disease, encephalitis, multiple encephalomyelitis, lymphoma. The diagnosis was established only by a brain biopsy - lymphocytic vasculitis was revealed. According to the immunohistochemical study, T-helpers predominated in the infiltrates. After pulse therapy with Metylprednisolon (1000 mg intravenously drip №. 5), the patient's condition almost returned to normal. It was recommended to take prednisolone per os (starting dose 60 mg) for 7 months.
Collapse
|