Intracranial hypertension related to cerebral venous thrombosis; and acute ischemic stroke with micro-infarcts associated with IgG4-related disease

Abstract

IgG4-related systemic disease (IgG4-RD) is characterized by an inflammatory reaction rich in IgG4-positive plasma cells, affecting multiple organs. This report describes a case who was diagnosed with IgG4-RD, having cerebral venous thrombosis and a subsequent acute ischemic stroke of undetermined cause. A 47-year-old woman presented with headache, visual disturbance and eyelid swelling and two years later she was admitted with acute attacks of mild left lower limb sensory-motor monoparesis. Indirect immunohistochemistry assay showed elevated level of IgG4, labeling neurons of the central nervous system, suggesting an immunological process possibly affecting vascular structures. Our experience suggests that IgG4-RD may be considered in patients with ischemic stroke and cerebral venous system involvement.

How to mimic a type A intramural hematoma: A case of IgG4‐related aortitis associated with cerebral hemorrhage

“…Possible immunological involvement of cerebral structures in IgG4-related disease has already been hypothesized. 8 As an intraoperative incidental finding, the aortic valve was bicuspid and this might be presumably correlated to the ascending aorta aneurysm and also to the histological aspect of the tunica media of the aorta, specifically with the disruption of the elastic fibers, as already extensively demonstrated in the literature. 9 Nonetheless, we cannot find any association between the bicuspid aortic valve and IgG4-related aortitis.…”

“…In light of this finding, looking back at the initial presentation, we can presume that the focal cerebral hemorrhage, causing visual disturbances and paresthesia to the patient, might have been due to a blood pressure peak on a background of an inflammatory process involving cerebral vascular structures, as demonstrated by the vascular lacunae and the irregular course of the abovementioned cerebral vessels. Possible immunological involvement of cerebral structures in IgG4‐related disease has already been hypothesized 8 …”

Cerebral Venous Sinus Thrombosis and Pachymeningitis in IgG4 Related Disease

“…In the available medical literature, there is paucity of reports of cerebral venous sinus thrombosis (CVST) secondary to HP in IgG4-RD. [ 2 3 ] In our cohort of 172 patients with CVST, two were due to IgG4-RD pachymeningitis. In this communication, we report these two CVST patients with IgG4-RD hypertrophic pachymeningitis in the light of reported literature.…”

“…Ekizoglu et al ., reported a 47-year-old woman with headache and visual impairment, who had CVST secondary to IgG4 related pachymeningitis. [ 2 ] Sireesha, et al . also reported superior sagittal sinus thrombosis in one out of six patients with HP secondary to IgG4-RD.…”

IgG4‐related disease associated with the primary manifestation of recurrent cerebral venous thrombosis: A rare case report

“…5 There are few reports of head and brain involvements of IgG4-RD in the form of hypertrophic pachymeningitis, cranial nerve impairments, pituitary gland inflammatory lesions, orbital pseudotumor, pterygopalatine fossa infiltrations, and recently central nervous system (CNS) parenchymal involvement. [6][7][8][9] Here, we established IgG4-RD diagnosis in a young woman who presented with recurrent cerebral venous thrombosis (CVT), pachymeningitis, and an orbital mass.…”