Intracranial vasculitis and multiple abscesses in a pregnant woman

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Cerebral vasculitis is a rare condition with diverse etiologies, frequently infectious (bacterial or viral).
• Purulent bacterial vasculitis is a known complication of severe bacterial meningitis.
• Cranial nerve palsies, particularly involving the cavernous sinus, are characteristic presentations.

Observation:

• A pregnant patient presented with a month-long history of sixth nerve palsy, followed by new-onset migraine and third nerve palsy.
• Initial workup, including lumbar puncture and non-contrast MRI, was unremarkable.
• Angiography demonstrated diffuse arterial irregularities, and subsequent MRI revealed leptomeningeal enhancement, abscess, and subdural empyema.

Findings:

• The patient's presentation and imaging findings were consistent with infectious vasculitis secondary to purulent meningitis.
• The case highlights the potential for negative or discordant early imaging results in infectious cerebral vasculitis.
• The rapid progression and cranial nerve involvement underscored the severity of the condition.

Implications:

• This case emphasizes the need for high clinical suspicion and potentially serial imaging in diagnosing infectious cerebral vasculitis, especially in pregnant patients.
• The association between pregnancy and infectious cerebral vasculitis requires further investigation.
• Prompt diagnosis and management are crucial due to the rapidly progressive and potentially devastating nature of the disease.