title: Why a standard contrast-enhanced MRI might be useful in intracranial internal carotid artery stenosis.
abstract: In patients with ischemic stroke of unknown cause cerebral vasculitis is a rare but relevant differential diagnosis, especially when signs of intracranial artery stenosis are found and laboratory findings show systemic inflammation. In such cases, high-resolution T1w vessel wall magnetic resonance imaging (MRI; 'black blood' technique) at 3 T is preferentially performed, but may not be available in every hospital. We report a case of an 84-year-old man with right hemispheric transient ischemic attack and signs of distal occlusion in the right internal carotid artery (ICA) in duplex sonography. Standard MRI with contrast agent pointed the way to the correct diagnosis since it showed an intramural contrast uptake in the right ICA and both vertebral arteries. Temporal artery biopsy confirmed the suspected diagnosis of a giant cell arteritis and dedicated vessel wall MRI performed later supported the suspected intracranial large artery inflammation. Our case also shows that early diagnosis and immunosuppressive therapy may not always prevent disease progression, as our patient suffered several infarcts in the left middle cerebral artery (MCA) territory with consecutive high-grade hemiparesis of the right side within the following four months.
authors.affiliation: Department of Neurology, Neurocenter, University of Freiburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Oeinck
authors.affiliation: Department of Radiology, Kreiskliniken Lörrach, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Rozeik
authors.affiliation: Department of Neurology, Kreiskliniken Lörrach, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Wattchow
authors.affiliation: Department of Neuroradiology, Neurocenter, University of Freiburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Meckel
authors.affiliation: Institute of Pathology, University Hospital Basel, Switzerland.
authors.forename: Manuel
authors.initials: M
authors.lastname: Schlageter
authors.affiliation: Department of Neurology, Kreiskliniken Lörrach, Germany.
authors.forename: Christel
authors.initials: C
authors.lastname: Beeskow
authors.affiliation: Department of Neurology, Neurocenter, University of Freiburg, Germany matthias.reinhard@uniklinik-freiburg.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Reinhard
mesh_terms: D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D018616:Ultrasonography, Doppler, Duplex
keywords: Intracranial internal carotid artery stenosis; cerebral vasculitis; cranial magnetic resonance imaging; giant cell arteritis; ischemic stroke