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Microscopic polyangiitis presenting with capsular warning syndrome and subsequent stroke

C W Tang1, P N Wang, K P Lin

  • 1Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan.

Journal of the Neurological Sciences
|November 27, 2008
PubMed

Insights

A patient experienced ischemic stroke due to microscopic polyangiitis, a rare autoimmune condition. Early diagnosis through specific antibodies and skin biopsy is crucial for managing this severe neurological event.

Area of Science:

  • Neurology
  • Rheumatology
  • Immunology

Background:

  • Capsular warning syndrome presents as transient neurological deficits preceding a major stroke.
  • Microscopic polyangiitis is a systemic vasculitis affecting small blood vessels.

Observation:

  • A 55-year-old man presented with recurrent transient dysarthria and left hemiplegia.
  • Brain MRI revealed bilateral basal ganglionic infarction, indicative of ischemic stroke.
  • The patient lacked typical stroke risk factors.

Findings:

  • Elevated perinuclear anti-neutrophilic cytoplasmic antibody (p-ANCA) titers were detected.
  • Skin biopsy confirmed leukocytoclastic venulitis, a hallmark of small-vessel vasculitis.
  • These findings confirmed microscopic polyangiitis as the underlying cause of stroke.

Implications:

  • This case highlights the importance of considering systemic vasculitis in cryptogenic strokes.
  • Prompt identification and treatment of microscopic polyangiitis can prevent further neurological damage.
  • Integrated neurological and rheumatological management is essential for patients with vasculitis-associated stroke.

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