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Microscopic polyangiitis presenting with medullary infarct.

Ayca Ozkul¹, Cengiz Tataroglu, Nefati Kiylioglu

¹Adnan Menderes University, Faculty of Medicine, Department of Neurology, 09100 Aydin, Turkey. ozkulayca@hotmail.com

Journal of the Neurological Sciences

|October 8, 2010

Summary

Microscopic polyangiitis, a rare small vessel vasculitis, can present with medullary infarction as an initial symptom. This case highlights an unusual neurological presentation of the disease.

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Area of Science:

Neurology
Rheumatology
Immunology

Background:

Microscopic polyangiitis (MPA) is a rare small vessel vasculitis.
Cerebrovascular disease is an uncommon complication of MPA.
MPA typically presents with constitutional symptoms, respiratory, or renal involvement.

Observation:

A 55-year-old woman presented with left medullary infarction.
Initial symptoms were neurological, with no overt signs of vasculitis.
During hospitalization, she developed retinal ischemia, mononeuritis multiplex, and pulmonary infiltrates.

Findings:

Sural nerve biopsy confirmed small vessel vasculitis.
Elevated C-reactive protein (CRP) and sedimentation rates, along with positive P-ANCA, supported the diagnosis of MPA.
The patient's presentation with medullary infarction as the first symptom is unprecedented in the literature.

Implications:

This case expands the spectrum of neurological presentations of microscopic polyangiitis.
Medullary infarction should be considered in the differential diagnosis of unexplained strokes, especially in the presence of systemic vasculitis.
Early recognition of MPA, even with atypical initial symptoms, is crucial for timely treatment and improved patient outcomes.