vasculitis Flashcards
vasculitis can either be..
part of disease process
or
a disease entity
when is vasculitis part of a disease process?
pachymeningitis in wegener’s granulomatosis
mononeuropathy multiplex in CTD
when can be vasculities be a disease entity?
granulomatosis angitis of CNS (20% OF CNS vasculitis)
isolated peripheral nerve vasculitis
what are the commonest presenting neurological features of vasculitis?
headaches
stroke like episodes/focal neurological deficits
encephalopathic (confusion, agitation, decreased level of consciousness)
foot drop/asymmetric neuropathy
what are three other non-neurological symptoms of vasculitis
systemically unwell
additional organ involvement
muscle involvement
what other additional neurological symptoms can present with vasculitis
mononeuropathy complex
cranial nerve palsies
cognitive deficits
what percentage of vasculitis is isolated to CNS?
26%
list 6 types of vasculitis
giant cell arteritis wegener's spectrum associated with CTD isolated pachymeningitis churg struass isolated to PNS
what are the differential diagnosis for vasculitis
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
what secondary causes of vasculitis exist?
HIV
varicella zoster
TB
syphilis
Hep C in association with mailgnancies
in association with connective tissue diseases
what signs would a blood test show for vasculitis
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
what would be the result of an immunology test for vasculitis?
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
in what percentage of vasculitis patients is the CSF examination abnormal? and what abnormalities are present?
up to 60-80%
raised protein (50%) lymphocytes (25%) OCB's (20%) matched bands (25%) blood (15%)
if the MRI is normal is it likely or unlikely that the patient has CNS vasculitis?
highly unlikely
what imaging techniques can be useful in diagnosing CNS vasculitis?
MRI
(imaging the arteries) MRA
CTA or 4 Vessel angiogram
( abnormal angiogram does not diagnose)
DWI- vasculitic strokes
what precipitating factors are associated with Reversible cerebral vasoconstriction syndrome but not vasculitis?
drugs: canabis, cocaine, emphatamines, ephedrine, erotamine, SSRI, IVigs
Pregnancy and pueperium
idiopathic
what features distinguish Reversible Cerebral vasoconstriction syndrome from CNS vasculitis?
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
what is the difference between vasculitis and vasculopathy?
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.
