NEURORADIOLOGY: Irregular Arterial Stenosis
Case Author: Megan K. Strother, MD, Vanderbilt University Medical Center
History
45-year-old woman with 2 days of headache and confusion.
Imaging Findings
Sagittal maximum-intensity-projection image from a CT angiogram shows irregular arterial narrowing in the distal anterior cerebral artery (arrow).
Diagnosis
Vasculitis
Teaching Points
Results of CSF analysis are abnormal in 80–90% of patients with primary angiitis (vasculitis) of the CNS. Patients with normal MRI findings and CSF generally do not need brain biopsy.
Vasculitis typically involves second- or third-order arterial branches. This pattern would be atypical for atherosclerosis and vasospasm, which usually involve proximal branches at the circle of Willis.
Suggested Readings
Birnbaum J, Hellmann DB. Primary angiitis of the central nervous system. Arch Neurol 2009; 66:704–709
White ML, Hadley WL, Zhang Y, Dogar MA. Analysis of central nervous system vasculitis with diffusion-weighted imaging and apparent diffusion coefficient mapping of the normal-appearing brain. AJNR 2007; 28:933–937
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