China
Africa
Explore chapters and articles related to this topic
Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
Overall prognosis and risk of death relate to the conscious level and extent of neurological impairment at presentation, which largely reflects the presence of hydrocephalus or cerebral vasculitis.
Diagnosis and classification
Published in Stephen Curran, John P. Wattis, Practical Management of Dementia, 2018
Cerebral vasculitis may cause repeated infarcts, and these may result in a dementia. The vasculitis usually involves many organs, resulting in other systemic features, e.g. systemic lupus erythematosus. Cognitive problems may also be noted after cerebral and extracerebral haemorrhages, often as a residual problem. Dementia may also occur as a result of multiple infarcts occurring during hypotensive crises, and as a result of chronic subdural haematomas.
Stroke in young people
Published in Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees, Stroke in Practice, 2017
Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees
SLE may present with stroke through a variety of mechanisms, including the induction of a prothrombotic state, an association with cardiac valvular inflammation (Liebman-Sachs endocarditis), and an association with cerebral vasculitis. The cerebral vasculitis of SLE may cause stroke; however, more common clinical manifestations include vasculitis-related encephalopathy, neuropsychiatric syndromes, and seizure.
Obesity in acute ischaemic stroke patients treated with intravenous thrombolysis therapy
Published in Neurological Research, 2023
Hongmin Li, Suliman Khan, Rabeea Siddique, Qian Bai, Yang Liu, Ruiyi Zhang, Yan Zhang, V. Wee Yong, Mengzhou Xue
One common cause of ischaemic stroke is an embolus in the cerebral vasculature that originates from an ulcerated and typically stenotic atherosclerotic plaque in the aortic arch, neck, or intracranial vessels [15]. Small vessel disease affects the smaller arteries and arterioles of the brain. It manifests in several ways, including lacunar stroke, leukoaraiosis (white matter changes that can be observed as T2-hyperintensities on MRI or hypodensities on CT), cerebral microbleeds, and intracerebral haemorrhage (ICH) [16]. Most arterial dissections that cause ischaemic stroke are in the extracranial carotid and vertebral arteries and can occlude the artery at the site of dissection or cause thrombus formation and distal embolism [17]. Cerebral vasculitis is rare but can occur as a primary central nervous system (CNS) angiitis or as a manifestation of systemic vasculitis. In these conditions, vessel wall inflammation can lead to luminal narrowing and thromboembolism causing ischaemic stroke and sometimes ICH [18].
Authors’ reply
Published in Scandinavian Journal of Rheumatology, 2020
V Garcia-Bustos, E Calabuig, J López-Aldeguer, P Moral Moral
On the other hand, the association between Chagas disease and ANCA-positive vasculitis is uncertain. Infection with T. cruzi causes a generalized vasculitis in many vascular beds which can affect both the microvasculature and large vessels (7, 8). Many experimental studies have shown perivascular inflammation, vascular necrosis, and endothelitis of coronary vessels, aorta, liver, or pulmonary vasculature in several animal models, including mice, dogs, and pigs (7–9). In humans, cerebral vasculitis has been reported (7). Other reports in patients with myositis in Chagas disease have documented muscle vasculitis (10), but the pathophysiological mechanisms are not well understood. Some vasoactive mediators have been implicated in the pathogenesis of Chagas disease vasculitis, such as bradykinin, endothelin-1, and thromboxane A2, but the work by Roffe et al (9) is the first one to demonstrate systemic necrotizing vasculitis driven by pathogen-specific type I immune responses. This advocates the idea that vasculitis may be driven by a pathogen-initiated autoimmune response in patients with Chagas disease.
Stroke Due to Cerebral Vasculitis in a Patient with Relentless Placoid Chorioretinitis
Published in Ocular Immunology and Inflammation, 2018
Eileen S. Hwang, James E. Bell, Edward P. Quigley, Robert E. Hoesch, Akbar Shakoor
APMPPE has been associated with strokes in rare cases. Luneau et al. reviewed 18 published cases of APMPPE-associated strokes that were attributed to cerebral vasculitis.3 Small vessel vasculopathy was found in nine of the ten patients who had cerebral angiography, and nine out of 12 patients who had lumbar punctures had cerebrospinal fluid pleocytosis. In contrast to APMPPE, serpiginous choroiditis has not been associated with cerebrovascular disease.4 RPC has features of both APMPPE and serpiginous choroiditis, and its systemic associations have not yet been clearly elucidated. There is one previously reported case of a patient with RPC with central nervous system disease. This patient had multifocal cerebral white matter lesions on magnetic resonance imaging that were consistent with small vessel cerebrovascular disease, but angiography was normal.5 Here, we provide the first case of RPC-associated central nervous system vasculitis proven by cerebral angiography. The etiology of the acute strokes in this case was clearly established by the diffuse small vessel irregularity present on cerebral angiography. Although the patient had a normal cerebrospinal fluid cell count, the lumbar puncture was performed after a week of high-dose steroids, and normal cell counts were found in three of the 12 cases reviewed by Luneau et al.3 The case we present of a previously healthy 20-year old with acute bilateral pontine stroke emphasizes the need for timely neurological evaluation in symptomatic patients with RPC.