Acute primary cerebral angiitis mimicking basilar artery dissection

Area of Science:

• Neurology
• Vascular Neurology
• Neuroradiology

Background:

• Basilar artery dissection and primary cerebral angiitis share similar initial symptoms.
• Accurate diagnosis is critical for appropriate treatment and patient outcomes.

Purpose of the Study:

• To highlight the diagnostic challenges in differentiating basilar artery dissection from primary cerebral angiitis.
• To emphasize the role of comprehensive angiography in diagnosis when advanced imaging is limited.

Main Methods:

• Case study of two patients with acute severe occipital headache and neurological deficits.
• Utilized conventional angiography of posterior and anterior circulation.
• Follow-up angiography was performed after 4 and 6 weeks.

Main Results:

• Initial angiography suggested basilar artery dissection in both patients.
• Absence of urgent magnetic resonance imaging (MRI) necessitated further investigation.
• Subsequent and control angiograms led to a diagnosis of primary cerebral angiitis.
• Corticosteroid treatment resulted in rapid clinical and angiographic improvement.

Conclusions:

• In cases where MRI is unavailable or inconclusive, initial findings of basilar artery dissection require further confirmation.
• Additional carotid angiography is essential to differentiate basilar artery dissection from diffuse cerebral angiitis.
• Prompt diagnosis and treatment with corticosteroids are effective for primary cerebral angiitis.