Vessel wall calcification and vascular event: Are we concerned enough?

A 49-year-old lady, hypertensive with dyslipidaemia, had thalamic bleed with intracranial multiple micro-haemorrhages. An extensive search was done and vasculitis was ruled out in the patient. Henceforth, she remained strict with medications and maintained blood pressure and lipids under control. After a lucid interval of 3 years, she attended emergency with complex partial seizure. We detected extensive microbleeds (significant increment) in magnetic resonance imaging of the brain and periventricular ischemic changes. A cerebrospinal fluid study and digital subtraction angiography of the brain were consistent with primary central nervous system (CNS) vasculitis (small vessel). She improved and currently is well on follow-up with immunosuppressive therapy. Interesting learning part in our case was late presentation of the patient with primary CNS vasculitis after a latency. It implies requirement of strong suspicion and stringent follow-up in these types of patients.