CEREBROVASCULAR COMPLICATIONS IN IMMUNOVA SCULITIS - 2 EXAMPLES OF DIFFERENT PATHOMECHANISMS

A 28-year-old woman with a history of headaches, TIA, WPW-syndrome and an abortion developed transient episodes of different neurological sy mptomes. CT and MRI revealed a temporo-parietal infarction. The CSF sh owed a discrete pleocytosis and autoantibodies against CNS. BSR, ANA, anti-Sm-ab and false positive VDRL and TPHA were pathologic. APTT was prolonged due to a lupus anticoagulant type I. Cerebral angiography wa s normal. SLE with thromboembolic infarction due to antiphospholipid a ntibody coagulopathy was diagnosed. Treatment were corticosteroids and ASA. A 55-year-old woman developed a frontal lobe syndrome after a PR IND four months ago. CT and MRI showed a right frontal process not typ ical for an infarction. Connective tissue disease and systemic arterio sclerosis were excluded. Cerebral angiography showed irregularities an d segmental narrowing of both internal carotid arteries and almost no filling of their branches. Parenchymal biopsy confirmed the diagnosis of an isolated angiitis of the CNS. In such cases immunosuppressive th erapy with corticosteroids and cyclophosphamide is recommended.