Santos MÁM, Valdés SRR, Vega TH

Language: Spanish
References: 15
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ABSTRACT

Introduction: Primary Vasculitis of Central Nervous System (PVCNS) is an infrequent entity, which affects small and middle vessels of brain and spine. Its etiology is unknown and it causes uncommon ictus presentation, being a diagnostic challenge. Case report: female patient, 42 years old, without vascular risk factors. Neurological deficits were repeated, with improvement and worsening, even under treatment with aspirin (ASA). At admission blood pressure was normal, such as other bio parameters. Cranial Magnetic Resonance Imaging (MRI) showed hiper intense heterogeneous image at T2, at subcortical and peri-silvian level of left brain hemisphere with sub-acute ischemic lesion, with deep and older lesions in left middle cerebral artery territory (LMCA). Angio-RMN showed multiple areas with stenosis of Right Middle Cerebral Artery and cortical area of LMCA, diagnosis of PVCNS was stated. Neurologic deficit showed slight improvement. Conventional arteriography confirms former findings of Angio-RMN. Hematologic and Immunologic disorders associated with thrombosis were ruled out. Treatment with metil-prednisolone was initiated, ASA was kept and oral Ciclofosfamide was continued. Patient showed slight hemiparesis at discharge. Conclusion: this case showed our experience in clinical practice, with a presentation of repeated ischemic ictus with Angio-RMN findings of PVCNS. Clinical and Imaging heterogeneous findings and the difficult diagnosis are demonstrated, where a high suspect it is required for its diagnosis. This constitutes a tool for professionals of the first, second a third level of medical attention and it contributes to the consideration and diagnosis of such difficult entity.

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