CEREBROSPINAL-FLUID AND THERAPY OF ISOLATED ANGIITIS OF THE CENTRAL-NERVOUS-SYSTEM

Background Serial cerebral angiograms, computed tomography, and magnet ic resonance imaging are among the proposed methods for monitoring dis ease activity and response to therapy in isolated angiitis of the cent ral nervous system. Cerebrospinal fluid has not proved to be useful in monitoring clinical course. Case Description We describe a 45-year-ol d man with histological diagnosis of isolated angiitis of the central nervous system that was treated with prednisone plus azathioprine and monitored for 2 years. Samples of the cerebrospinal fluid were obtaine d for cytological and routine chemical examination, as well as albumin and immunoglobulin content. Before treatment, cerebrospinal fluid sho wed marked plasmatic transudation of albumin and intrathecal synthesis of immunoglobulins. During the first year of immunosuppression no eve nts were noticed, and the previously abnormal aspects of the cerebrosp inal fluid showed improvement. During the weaning of azathioprine, a n ew stroke occurred in conjunction with a marked deterioration of cereb rospinal fluid parameters. Immunosuppression was resumed at previous l evels, and during the following year no further events occurred. Once again, abnormal cerebrospinal fluid values improved significantly. Con clusions We report a case of isolated angiitis of the central nervous system in which the serial cerebrospinal fluid examinations (albumin a nd immunoglobulin content) showed a close correlation with clinical co urse. This method may be useful in monitoring response to therapy.