Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova · 2025
[Primary vasculitis of the intracranial arteries and cerebrovascular disorders].
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Kalashnikova L A, Dreval M V, Zacharchuk S A, Shabalina A A, Dobrynina L A
Аннотация
OBJECTIVE: To study the features of cerebrovascular accidents (CVAs) in patients with primary vasculitis of the intracranial arteries (PVICA) and the change of contrast agent uptake by the vascular wall after treatment with corticosteroids.
MATERIAL AND METHODS: The study included 34 patients (19 males, 56%; mean age 41.4±8.8 years) with CVA associated with PVICA. All patients underwent MR angiography (MRA) of the intracranial arteries and a high-resolution MRI scan of the vascular wall before and after the contrast agent (CA) injection. Twenty-seven patients were treated with corticosteroids, and 25 of them were followed up.
RESULTS: Of the 34 study patients, 76% had CVA in the form of ischemic stroke (IS), which recurred in 29% of patients. Repeated transient CVAs (tCVAs) were reported in 82%. In 91% of cases, IS and tCVA occurred in the internal carotid artery (ICA) system. The National Institutes of Health Stroke Scale (NIHSS) showed mild or moderate IS in 96% of patients. MRA of the intracranial arteries revealed stenoses (56%), occlusions (12%), or their combination (32%). The CA uptake by the vascular wall was detected in all patients. After treatment with corticosteroids, 80% of 25 patients followed up for 29.1±28.7 months showed a clinical improvement. Repeated MRI of the vascular wall, performed in 16 patients within 21.1±26.3 months after treatment, showed the absence or decreased CA uptake in 4 patients, increased uptake in 2 patients, and no change in the uptake in 10 patients.
CONCLUSION: CVAs in patients with PVICA usually occur as a minor stroke or repeated CVAs, and in 91% of cases, they involve the ICA system. Treatment with corticosteroids is effective in 80% of patients. The persistence of CA uptake by the vascular wall, as observed by MRI after treatment with clinical improvement, is likely due to post-inflammatory fibrosis.
MATERIAL AND METHODS: The study included 34 patients (19 males, 56%; mean age 41.4±8.8 years) with CVA associated with PVICA. All patients underwent MR angiography (MRA) of the intracranial arteries and a high-resolution MRI scan of the vascular wall before and after the contrast agent (CA) injection. Twenty-seven patients were treated with corticosteroids, and 25 of them were followed up.
RESULTS: Of the 34 study patients, 76% had CVA in the form of ischemic stroke (IS), which recurred in 29% of patients. Repeated transient CVAs (tCVAs) were reported in 82%. In 91% of cases, IS and tCVA occurred in the internal carotid artery (ICA) system. The National Institutes of Health Stroke Scale (NIHSS) showed mild or moderate IS in 96% of patients. MRA of the intracranial arteries revealed stenoses (56%), occlusions (12%), or their combination (32%). The CA uptake by the vascular wall was detected in all patients. After treatment with corticosteroids, 80% of 25 patients followed up for 29.1±28.7 months showed a clinical improvement. Repeated MRI of the vascular wall, performed in 16 patients within 21.1±26.3 months after treatment, showed the absence or decreased CA uptake in 4 patients, increased uptake in 2 patients, and no change in the uptake in 10 patients.
CONCLUSION: CVAs in patients with PVICA usually occur as a minor stroke or repeated CVAs, and in 91% of cases, they involve the ICA system. Treatment with corticosteroids is effective in 80% of patients. The persistence of CA uptake by the vascular wall, as observed by MRI after treatment with clinical improvement, is likely due to post-inflammatory fibrosis.