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Neurocritical Care
Published in: Neurocritical Care 3/2010

01-06-2010 | Original Article

Infectious Vasculopathy of Intracranial Large- and Medium-Sized Vessels in Neurological Intensive Care Unit: A Clinico-Radiological Study

Authors: J. Katchanov, E. Siebert, R. Klingebiel, M. Endres

Published in: Neurocritical Care | Issue 3/2010

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Abstract

Background

Infections are a well-known cause of cerebral vasculopathy and vasculitis. We aimed to analyze the frequency of intracranial vasculopathy attributable to infection, the spectrum of causative microorganisms, imaging, and cerebrospinal fluid (CSF) characteristics as well as clinical course and outcome.

Methods

We used our institution’s medical record system to identify all patients diagnosed with nonatherosclerotic central nervous system vasculopathy from January 1, 1999 through February 28, 2009. We reviewed their clinical charts, imaging data, and results of CSF studies.

Results

Twenty-five adult patients with nonatherosclerotic cerebral vasculopathy of large- and medium-sized intracranial vessels were identified. Eight patients had vasculopathy attributable to infection (32%). The underlying pathologies were acute bacterial meningitis (n = 4), varicella zoster virus (VZV) infection (n = 2), borreliosis (n = 1), and syphilis (n = 1). In six patients, magnetic resonance angiography was performed and showed vasculopathic changes in all patients examined (100%). In both patients with VZV-associated vasculopathy, the arterial wall enhanced on magnetic resonance imaging. The CSF examination of the patients with infectious vasculopathy showed a significantly higher white blood cell count. The outcome of the infectious cohort was unfavorable with one death, two patients with locked-in syndrome, and five patients discharged from intensive care with severe neurological deficits.

Conclusion

In this cohort, one-third of all cases of nonatherosclerotic vasculopathy were due to infectious vasculopathy of large and medium intracranial vessels.
Literature
1.
Villablanca JP, Rodriguez FJ, Stockman T, Dahliwal S, Omura M, Hazany S, et al. MDCT angiography for detection and quantification of small intracranial arteries: comparison with conventional catheter angiography. AJR Am J Roentgenol. 2007;188:593–602.CrossRefPubMed
2.
Klingebiel R, Kentenich M, Bauknecht HC, Masuhr F, Siebert E, Busch M, et al. Comparative evaluation of 64-slice CT angiography and digital subtraction angiography in assessing the cervicocranial vasculature. Vasc Health Risk Manag. 2008;4:901–7.PubMed
3.
4.
Biller J. Non-atherosclerotic cerebral vasculopathies in young. J Stroke Cerebrovasc Dis. 1997;6:173–7.CrossRefPubMed
5.
6.
Rossi CM, Di Comite G. The clinical spectrum of the neurological involvement in vasculitides. J Neurol Sci. 2009;285:13–21.CrossRefPubMed
7.
Gilden DH. Varicella zoster encephalopathy and disseminated encephalomyelitis. J Neurol Sci. 2002;195:99–101.CrossRefPubMed
8.
Lyons EL, Leeds NE. The angiographic demonstration of arterial vascular disease in purulent meningitis. Radiology. 1967;88:935–8.PubMed
9.
Katrak SM, Shembalkar PK, Bijwe SR, Bhandarkar LD. The clinical, radiological and pathological profile of tuberculous meningitis in patients with and without human immunodeficiency virus infection. J Neurol Sci. 2000;181:118–26.CrossRefPubMed
10.
Veenendaal-Hilbers JA, Perquin WV, Hoogland PH, Doorbos L. Basal meningovasculitis and occlusion of the basilar artery in two cases of Borrelia burgdorferi infection. Neurology. 1988;38:1317–9.PubMed
11.
Pugin D, Copin JC, Goodyear MC, Landis T, Gasche Y. Persisting vasculitis after pneumococcal meningitis. Neurocrit Care. 2006;4:237–40.CrossRefPubMed
12.
van de Beek D, Rabinstein AA, Peters SG, Cloft H, Wijdicks EF. Staphylococcus endocarditis associated with infectious vasculitis and recurrent cerebral hemorrhages. Neurocrit Care. 2008;8:48–52.CrossRefPubMed
13.
Giang DW. Central nervous system vasculitis secondary to infections, toxins, and neoplasms. Semin Neurol. 1994;14:313–9.CrossRefPubMed
14.
Calabrese LH, Mallek JA. Primary angiitis of the central nervous system: report of 8 new cases, review of the literature, and proposal for diagnostic criteria. Medicine (Baltimore). 1988;67:20–39.
15.
Katchanov J, Siebert E, Endres M, Klingebiel R. Focal parenchymal lesions in community-acquired bacterial meningitis in adults: a clinico-radiological study. Neuroradiology. 2009;51:723–9.CrossRefPubMed
16.
Katchanov J, Bohner G, Schultze J, Klingebiel R, Endres M. Tuberculous meningitis presenting as mesencephalic infarction and syringomyelia. J Neurol Sci. 2007;260:286–7.CrossRefPubMed
17.
Pfister HW, Borasio GD, Dirnagl U, Bauer M, Einhaupl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology. 1992;42:1497–504.PubMed
18.
Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, et al. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology. 2008;70:853–60.CrossRefPubMed
19.
Elkind MS, Wright C. Cerebral vasculopathy does not equal primary central nervous system vasculitis. Ann Neurol. 2008;64(2):228.CrossRefPubMed
20.
Alreshaid AA, Powers WJ. Prognosis of patients with suspected primary CNS angiitis and negative brain biopsy. Neurology. 2003;61:831–3.PubMed
21.
Kadkhodayan Y, Alreshaid A, Moran CJ, Cross DT III, Powers WJ, Derdeyn CP. Primary angiitis of the central nervous system at conventional angiography. Radiology. 2004;233:878–82.CrossRefPubMed
22.
Salvarani C, Brown RD Jr, Calamia KT, Christianson TJ, Weigand SD, Miller DV, et al. Primary central nervous system vasculitis: analysis of 101 patients. Ann Neurol. 2007;62:442–51.CrossRefPubMed
23.
Goldstein LB. Primary central nervous system vasculitis: is biopsy appropriate? Ann Neurol. 2008;64:228.CrossRefPubMed
24.
Melanson M, Chalk C, Georgevich L, Fett K, Lapierre Y, Duong H, et al. Varicella-zoster virus DNA in CSF and arteries in delayed contralateral hemiplegia: evidence for viral invasion of cerebral arteries. Neurology. 1996;47:569–70.PubMed
25.
Gilden D, Cohrs RJ, Mahalingam R, Nagel MA. Varicella zoster virus vasculopathies: diverse clinical manifestations, laboratory features, pathogenesis, and treatment. Lancet Neurol. 2009;8:731–40.CrossRefPubMed
26.
Küker W, Gaertner S, Nagele T, Dopfer C, Schoning M, Fiehler J, et al. Vessel wall contrast enhancement: a diagnostic sign of cerebral vasculitis. Cerebrovasc Dis. 2008;26:23–9.CrossRefPubMed
27.
28.
Appenzeller S, Faria AV, Zanardi VA, Fernandes SR, Costallat LT, Cendes F. Vascular involvement of the central nervous system and systemic diseases: etiologies and MRI findings. Rheumatol Int. 2008;28:1229–37.CrossRefPubMed
29.
Pipitone N, Versari A, Salvarani C. Role of imaging studies in the diagnosis and follow-up of large-vessel vasculitis: an update. Rheumatology (Oxford). 2008;47:403–8.CrossRef
30.
Angstwurm K, Borges AC, Halle E, Schielke E, Einhäupl KM, Weber JR. Timing the valve replacement in infective endocarditis involving the brain. J Neurol. 2004;251:1220–6.CrossRefPubMed
31.
Berlit P. Isolated angiitis of the CNS and bacterial endocarditis: similarities and differences. J Neurol. 2009;256:792–5.CrossRefPubMed
32.
Miyazaki Y, Riku Y, Goto Y, Mano K, Yoshida M, Hashizume Y. VZV vasculopathy associated with myelo-radiculoganglio-meningo-encephalitis: an autopsy case of an immunocompetent 66-year-old male. J Neurol Sci. 2008;275:42–5.CrossRefPubMed
33.
Uldry PA, Regli F, Bogousslavsky J. Cerebral angiopathy and recurrent strokes following Borrelia burgdorferi infection. J Neurol Neurosurg Psychiatry. 1987;50:1703–4.CrossRefPubMed
34.
Topakian R, Stieglbauer K, Nussbaumer K, Aichner FT. Cerebral vasculitis and stroke in Lyme neuroborreliosis. Cerebrovasc Dis. 2008;26:455–61.CrossRefPubMed
35.
McGee S, Hirschmann J. Use of corticosteroids in treating infectious diseases. Arch Intern Med. 2008;168:1034–46.CrossRefPubMed
36.
Endres M. Statins: potential new indications in inflammatory conditions. Atheroscler Suppl. 2006;7:31–5.CrossRefPubMed
37.
de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347:1549–56.CrossRefPubMed
38.
van de Beek D, de Gans J. Dexamethasone and pneumococcal meningitis. Ann Intern Med. 2004;141:327.PubMed
39.
Twaites GE, Macmullen-Price J, Chau TTH, Mai PP, Dung T, Simmons CP, et al. Serial MRI to determine the effect of Dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study. Lancet Neurol. 2007;6:230–6.CrossRef
40.
Schut ES, Brouwer MC, de Gans J, Florquin S, Troost D, van de Beek D. Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis. Neurology. 2009;73:1988–95.CrossRefPubMed
Metadata
Title
Infectious Vasculopathy of Intracranial Large- and Medium-Sized Vessels in Neurological Intensive Care Unit: A Clinico-Radiological Study
Authors
J. Katchanov
E. Siebert
R. Klingebiel
M. Endres
Publication date
01-06-2010
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 3/2010
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-010-9335-4

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