vasculitis

Question 1

vasculitis can either be..

Answer 1

part of disease process

or

a disease entity

Question 2

when is vasculitis part of a disease process?

Answer 2

pachymeningitis in wegener’s granulomatosis

mononeuropathy multiplex in CTD

Question 3

when can be vasculities be a disease entity?

Answer 3

granulomatosis angitis of CNS (20% OF CNS vasculitis)

isolated peripheral nerve vasculitis

Question 4

what are the commonest presenting neurological features of vasculitis?

Answer 4

headaches

stroke like episodes/focal neurological deficits

encephalopathic (confusion, agitation, decreased level of consciousness)

foot drop/asymmetric neuropathy

Question 5

what are three other non-neurological symptoms of vasculitis

Answer 5

systemically unwell
additional organ involvement
muscle involvement

Question 6

what other additional neurological symptoms can present with vasculitis

Answer 6

mononeuropathy complex
cranial nerve palsies
cognitive deficits

Question 7

what percentage of vasculitis is isolated to CNS?

Answer 7

26%

Question 8

list 6 types of vasculitis

Answer 8

giant cell arteritis
wegener's spectrum
associated with CTD
isolated pachymeningitis
churg struass
isolated to PNS

Question 9

what are the differential diagnosis for vasculitis

Answer 9

CNS infections : HSE, TB, viral encephalitis, HIV

CNS malignancy: malignant meningitis, lymphomas

venous sinus thrombosis

subarachnoid haemorrhage/vasospasm

embolic strokes due to SBE

reversible cerebral vasoconstriction

Question 10

what secondary causes of vasculitis exist?

Answer 10

HIV
varicella zoster
TB
syphilis

Hep C in association with mailgnancies

in association with connective tissue diseases

Question 11

what signs would a blood test show for vasculitis

Answer 11

raised inflammatory markers at baseline

ESR 80% (mean 70)
CRP 70% (mean 93)
Low Albumin 73%
normochromic anaemia 57%

high platelet count 46%

although up to 20% show no abnormalities

Question 12

what would be the result of an immunology test for vasculitis?

Answer 12

one or more abnormalities in <50%

RF
P OR C ANCA with positive MPX, MP3

ANF, Ro and/or LA (ENA)

Cryoglobulins
lots of patients havw MGUS

Question 13

in what percentage of vasculitis patients is the CSF examination abnormal? and what abnormalities are present?

Answer 13

up to 60-80%

raised protein (50%)
lymphocytes (25%)
OCB's (20%)
matched bands (25%)
blood (15%)

Question 14

if the MRI is normal is it likely or unlikely that the patient has CNS vasculitis?

Answer 14

highly unlikely

Question 15

what imaging techniques can be useful in diagnosing CNS vasculitis?

Answer 15

MRI

(imaging the arteries) MRA
CTA or 4 Vessel angiogram
( abnormal angiogram does not diagnose)

DWI- vasculitic strokes

Question 16

what precipitating factors are associated with Reversible cerebral vasoconstriction syndrome but not vasculitis?

Answer 16

drugs: canabis, cocaine, emphatamines, ephedrine, erotamine, SSRI, IVigs

Pregnancy and pueperium

idiopathic

Question 17

what features distinguish Reversible Cerebral vasoconstriction syndrome from CNS vasculitis?

Answer 17

female predominance

acute onset headache (Mimicks SAH)

usually no prodromal illness

no focal neurology

abnormal angiogram or CTA or MRA

usually normal MRI but may have cortical SAH, intracerebral bleed or CVA

Question 18

what is the difference between vasculitis and vasculopathy?

Answer 18

Vasculitis denotes a heterogeneous group of clinical entities which all are characterized by the inflammatory process of arterial and venous walls of any size and in any organ, quite frequently in the skin.

Vasculopathy, on the other hand, refers to vascular and capillary lesions caused by, for example, some medications.