title: Central nervous system venulitis presenting as migraine.
abstract: OBJECTIVE
  To describe a case of pediatric central nervous system (CNS) venulitis.
  
  
  BACKGROUND
  Primary angiitis of the CNS is a rare but increasingly well-recognized cause of morbidity in children. It primarily involves the arteries and arterioles of the CNS, with only 1 published case of a pediatric patient found to have isolated CNS venulitis on brain biopsy.
  
  
  METHODS
  A 17-year-old female with a 4-year history of migraines presented with increasingly frequent migraines and right-sided hemiplegia. Infectious, hematologic, and rheumatologic work-ups were negative. Brain magnetic resonance imaging showed multiple rim-enhancing lesions consistent with calcifications affecting the deep left white matter. On brain biopsy, there was evidence of an inflammatory process involving small veins and venules. The patient displayed clinical improvement with a course of high-dose steroids and 6 monthly cyclophosphamide infusions followed by maintenance therapy with mycophenolate mofetil.
  
  
  CONCLUSIONS
  We describe a case of pediatric CNS venulitis presenting with migraine.
authors.affiliation: Children's Hospital of Eastern Ontario, ON, Canada; University of Ottawa, ON, Canada.
authors.forename: Serena L
authors.initials: SL
authors.lastname: Orr
authors.forename: Marlise P
authors.initials: MP
authors.lastname: Dos Santos
authors.forename: Roman
authors.initials: R
authors.lastname: Jurencak
authors.forename: Jean
authors.initials: J
authors.lastname: Michaud
authors.forename: Elka
authors.initials: E
authors.lastname: Miller
authors.forename: Asif
authors.initials: A
authors.lastname: Doja
mesh_terms: D000293:Adolescent; D001921:Brain / Q000098:blood supply / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008881:Migraine Disorders / Q000209:etiology*; D020293:Vasculitis, Central Nervous System / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D014680:Veins / Q000473:pathology*
chemical_list: D007166:Immunosuppressive Agents
keywords: central nervous system vasculitis; central nervous system venulitis; headache; migraine; pediatric; primary angiitis of the central nervous system