CEREBRAL VASCULITIS - RECOGNITION, DIAGNOSIS AND MANAGEMENT

Cerebral vasculitis is a serious but uncommon condition which presents considerable difficulties in recognition, diagnosis and treatment. We studied eight consecutive patients in whom this diagnosis was made. D espite the great diversity of symptoms and signs, we noted three clini cal patterns: (i) acute or sub-acute encephalopathy, (ii) a picture wi th some similarities to multiple sclerosis ('MS-plus'), and (iii) feat ures of a rapidly progressive space-occupying lesion. The identificati on of these patterns may help recognition of cerebral vasculitis. The diagnostic value of four investigative procedures not previously studi ed in cerebral vasculitis was assessed: ophthalmological examination u sing low-dose fluorescein angiography with slit-lamp video microscopy of the anterior segment (abnormal in 4/5 patients); spinal fluid oligo clonal band analysis (abnormal in 3/6 patients); anti-neutrophil cytop lasmic antibody assay (abnormal in 3/8 patients); and indium-labelled white-cell cerebral imaging (positive in only one patient). Treatment was with steroid alone (n = 2) or steroid with cyclophosphamide (n = 6 ). Seven patients responded clinically.