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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
PubMed

Insights

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.

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.

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