title: Central nervous system vasculitis: still more questions than answers.
abstract: The central nervous system (CNS) may be involved by a variety of inflammatory diseases of blood vessels. These include primary angiitis of the central nervous system (PACNS), a rare disorder specifically targeting the CNS vasculature, and the systemic vasculitides which may affect the CNS among other organs and systems. Both situations are severe and convey a guarded prognosis. PACNS usually presents with headache and cognitive impairment. Focal symptoms are infrequent at disease onset but are common in more advanced stages. The diagnosis of PACNS is difficult because, although magnetic resonance imaging is almost invariably abnormal, findings are non specific. Angiography has limited sensitivity and specificity. Brain and leptomeningeal biopsy may provide a definitive diagnosis when disclosing blood vessel inflammation and are also useful to exclude other conditions presenting with similar findings. However, since lesions are segmental, a normal biopsy does not completely exclude PACNS. Secondary CNS involvement by systemic vasculitis occurs in less than one fifth of patients but may be devastating. A prompt recognition and aggressive treatment is crucial to avoid permanent damage and dysfunction. Glucocorticoids and cyclophosphamide are recommended for patients with PACNS and for patients with secondary CNS involvement by small-medium-sized systemic vasculitis. CNS involvement in large-vessel vasculitis is usually managed with high-dose glucocorticoids (giant-cell arteritis) or glucocorticoids and immunosuppressive agents (Takayasu's disease). However, in large vessel vasculitis, where CNS symptoms are usually due to involvement of extracranial arteries (Takayasu's disease) or proximal portions of intracranial arteries (giant-cell arteritis), revascularization procedures may also have an important role.
authors.affiliation: Vasculitis Research Unit, Department of Systemic Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Alba
authors.forename: Georgina
authors.initials: G
authors.lastname: Espígol-Frigolé
authors.forename: Sergio
authors.initials: S
authors.lastname: Prieto-González
authors.forename: Itziar
authors.initials: I
authors.lastname: Tavera-Bahillo
authors.forename: Ana
authors.initials: A
authors.lastname: García-Martínez
authors.forename: Montserrat
authors.initials: M
authors.lastname: Butjosa
authors.forename: José
authors.initials: J
authors.lastname: Hernández-Rodríguez
authors.forename: Maria C
authors.initials: MC
authors.lastname: Cid