title: Recurrent leukoencephalopathy with microhemorrhages: gradient-echo MRI study diagnostic value in CNS primary angiitis.
abstract: Diagnosis of primary angiitis of the central nervous system (PACNS) is difficult in relation to variability in its clinical manifestations and absence of specific signs in neuroimaging. A young patient presented with a recurrent encephalopathic clinical course. T2 and fluid-attenuated inversion recovery-magnetic resonance imaging (FLAIR-MRI) showed hyperintense lesions in the cerebral white matter suggesting demyelination. Those lesions decreased or even disappeared after treatment with steroids and immunoglobulins. In echo gradient MRI (T2*-MRI), there were permanent cortical-subcortical petechial hypointense lesions (microhemorrhages). Definite diagnosis was established after cerebral biopsy. Intravenous cyclophosphamide was administrated with no new relapses in more than 18 months of follow-up. In a compatible clinical course, the finding of petechial hemorrhages in T2*-WI could play an important role in early diagnosis of PACNS.
authors: Department of Neurology, Complexo Hospitalario, Universitario, Santiago de Compostela, Spain. mariasg@meditex.es
authors: M
authors: M
authors: Arias
authors: Xr
authors: X
authors: Osorio
authors: D
authors: D
authors: Dapena
authors: S
authors: S
authors: Arias-Rivas
authors: F
authors: F
authors: Vázquez
mesh_terms: D000328:Adult; D002543:Cerebral Hemorrhage / Q000473:pathology*; D006801:Humans; D004684:Leukoencephalitis, Acute Hemorrhagic / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D012008:Recurrence; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis / Q000473:pathology*