Cerebral vasculitis

The cerebral vasculitis is very rare immunologically induced inflammation in the vessel walls.

Cerebral vasculitis can occur as part of what is known as primary CNS vasculitis (isolated CNS vasculitis) or in conjunction with systemic vasculitis or infectious diseases. Unclear stroke symptoms in younger patients should lead to the exclusion of vasculitis.

The main symptoms are headaches, neurological deficits and changes in personality as well as strokes. Systemic vasculitis is characterized by acute signs of inflammation and the combination with peripheral neurological manifestations (often painful inflammation of the nerves) and manifestations in other organs (joints, skin, eyes, kidneys, lungs, heart).

If the combination of neurological and systemic symptoms results in a justified clinical suspicion of vasculitis, the diagnosis must be narrowed down before initiating immunosuppressive therapy - this also includes the administration of corticosteroids . As a rule, a broad organ-related and laboratory chemical diagnosis is required for this.

In isolated CNS vasculitis, pathological findings in the nerve fluid ( cerebrospinal fluid ) are decisive. Imaging methods ( magnetic resonance tomography , magnetic resonance angiography ), CSF and serum findings as well as the histological confirmation of the diagnosis are groundbreaking in diagnostics. Conventional angiography is usually also required. Differential diagnostics to differentiate it from other tumor forms is very difficult in MRI / CT and can usually only be carried out postoperatively by the pathologist .

Therapeutically, depending on the cause , treatment is usually immunosuppressive with corticosteroids and other immunosuppressants ( cyclophosphamide , azathioprine ). Neurosurgical intervention may also be necessary in the case of a corresponding tumor-like lesion.

Web links

S1 guideline for cerebral vasculitis of the German Society for Neurology (DGN). In: AWMF online (as of 2018)