Cerebral Vasculitis

Preliminary Diagnosis: Cerebral Casculitis

I. What imaging technique is first-line for this diagnosis?

Contrast MRI of the brain with MRA of the head

II. Describe the advantages and disadvantages of this technique for diagnosis of cerebral vasculitis.

Advantages

• Able to detail gray and white matter with exquisite detail

• Able to localize the anterior and posterior cerebral vasculature

• Able to evaluate the vasculature for any signs of vasculitis (beading and/or stenosis) with a reasonable degree of sensitivity and specificity

• Does not expose a patient to ionizing radiation

Disadvantages

• May be subject to motion artifact, which degrades image quality

• Expensive

III. What are the contraindications for the first-line imaging technique?

May not be performed in patients with non MR compatible hardware

IV. What alternative imaging techniques are available?

Catheter angiography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of cerebral vasculitis.

Catheter angiography

Advantages

• It is the gold standard imaging modality, which is able to evaluate the intracerebral vasculature and diagnose cerebral vascultiis with great specificity and sensitivity.

Disadvantages

• More expensive than MRI

• Exposes the patient to ionizing radiation

• It is an invasive procedure with potential for more complications.

VI. What are the contraindications for the alternative imaging techniques?

Catheter angiography

Contraindicated in patients in a severe hypocoagulable state (platelets <50,000 or INR >2.0).