Stroke and cerebral vasculitis: A 10-year clinical experience.

Abstract

Background: Angiitis of the central nervous system (CNS) is difficult to diagnose but potentially fatal. It usually causes infarction of brain tissue. When stroke occurs in a younger individual or is associated multiple infarcts on imaging, clinicians must decide how far to pursue a possible diagnosis of vasculitis. The aim of this study is to establish the prevalence of primary and secondary cerebral angiitis among patients presenting with stroke. Method(s): Hospital attendances over a 10-year period were surveyed by searching for diagnostic codes and key words specific for cerebral vasculitis/angiitis. Case notes were reviewed by the authors using 2 sets of criteria for angiitis of the CNS. Result(s): Thirty-two patients were initially considered likely to have cerebral angiitis by treating physicians. Thirteen had been admitted to hospital with stroke. During this period, there were 7475 admissions for ischemic and hemorrhagic stroke. Six patients had a final diagnosis of vasculitic stroke but only one had definite CNS angiitis with a first presentation as ischemic stroke (0.02%). Most patients who did have cerebral vasculitis developed multifocal or subacute neurological deficits, or already had an immunological disorder known to be associated with secondary CNS angiitis. Of 19 patients given an alternative final diagnosis, the commonest were atherosclerotic/ embolic cerebrovascular disease (9) and reversible cerebral vasoconstriction syndrome (7). Conclusion(s): Stroke is rarely the first manifestation of cerebral vasculitis. Our findings suggest that routine screening for angiitis in stroke patients may not be warranted.