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March 03, 2020; 94 (9) Resident & Fellow Section

Pearls & Oy-sters: Primary angiitis of the CNS presenting with recurrent intracranial hemorrhage

Jessica Rice, Randall Woltjer, Nicholas Stienstra, Elizabeth Sun, Vijayshree Yadav
First published February 10, 2020, DOI: https://doi.org/10.1212/WNL.0000000000009047
Jessica Rice
From the Department of Neurology, Oregon Health & Science University, Portland.
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Randall Woltjer
From the Department of Neurology, Oregon Health & Science University, Portland.
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Nicholas Stienstra
From the Department of Neurology, Oregon Health & Science University, Portland.
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Elizabeth Sun
From the Department of Neurology, Oregon Health & Science University, Portland.
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Vijayshree Yadav
From the Department of Neurology, Oregon Health & Science University, Portland.
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Citation
Pearls & Oy-sters: Primary angiitis of the CNS presenting with recurrent intracranial hemorrhage
Jessica Rice, Randall Woltjer, Nicholas Stienstra, Elizabeth Sun, Vijayshree Yadav
Neurology Mar 2020, 94 (9) e992-e995; DOI: 10.1212/WNL.0000000000009047

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    Figure Pathologic findings associated with primary angiitis of the CNS (PACNS) and brain MRI

    (A) Leptomeningeal surface with diffuse mononuclear infiltrate (arrow, upper portion of figure) extending into superficial cortex (lower portion of figure). (B) Leptomeningeal vascular and perivascular inflammation with focal granuloma formation (arrow). (C) Some leptomeningeal vessels show complete obliteration with fibrotic lumens and transmural inflammation (arrow). (D) Cerebral digital subtraction angiography, sagittal view, shows subtle areas of multifocal narrowing in the right middle cerebral artery (arrows). (E) Axial contrast-enhanced T1-weighted image shows left frontal lobe and diffuse leptomeningeal enhancement (arrow). (F) T2*-weighted image shows multiple hemorrhages of different ages in the right and left frontal lobes. Scale bars: 200 μm.

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