Sarcoid vasculitis presenting with stroke: 3D T1 dark blood vessel wall imaging

Castro, Pedro; Santos, Roberto Queiroz dos; Machado, Dequitier Carvalho; Schmidt, Felipe da Rocha; Moreira, Denise Madeira

doi:10.1590/0004-282x20190067

Cited by 3 publications

(1 citation statement)

References 2 publications

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“…25,26 More recent sporadic case reports have also noted CNS vasculitis on conventional angiography or VWI, albeit in patients presenting with stroke. 27,28 Our study, however, documents the extent and distribution of vascular abnormalities in patients with NS without a distinct stroke-like syndrome.…”

Section: Discussionmentioning

confidence: 53%

Vascular Involvement in Neurosarcoidosis

Bathla

Abdel-Wahed

Agarwal

et al. 2021

Neurol Neuroimmunol Neuroinflamm

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Background and ObjectivesCerebrovascular manifestations in neurosarcoidosis (NS) were previously considered rare but are being increasingly recognized. We report our preliminary experience in patients with NS who underwent high-resolution vessel wall imaging (VWI).MethodsA total of 13 consecutive patients with NS underwent VWI. Images were analyzed by 2 neuroradiologists in consensus. The assessment included segment-wise evaluation of larger- and medium-sized vessels (internal carotid artery, M1-M3 middle cerebral artery; A1-A3 anterior cerebral artery; V4 segments of vertebral arteries; basilar artery; and P1-P3 posterior cerebral artery), lenticulostriate perforator vessels, and medullary and deep cerebral veins. Cortical veins were not assessed due to flow-related artifacts. Brain biopsy findings were available in 6 cases and were also reviewed.ResultsMean patient age was 54.9 years (33–71 years) with an M:F of 8:5. Mean duration between initial diagnosis and VWI study was 18 months. Overall, 9/13 (69%) patients had vascular abnormalities. Circumferential large vessel enhancement was seen in 3/13 (23%) patients, whereas perforator vessel involvement was seen in 6/13 (46%) patients. Medullary and deep vein involvement was also seen in 6/13 patients. In addition, 7/13 (54%) patients had microhemorrhages in susceptibility-weighted imaging, and 4/13 (31%) had chronic infarcts. On biopsy, 5/6 cases showed perivascular granulomas with vessel wall involvement in all 5 cases.DiscussionOur preliminary findings suggest that involvement of intracranial vascular structures may be a common finding in patients with NS and should be routinely looked for. These findings appear concordant with previously reported autopsy literature and need to be validated on a larger scale.

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