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[Case of CNS-limited ANCA-associated vasculitis presenting as recurrent ischemic stroke]

Kayo Wakisaka1, Noriko Hagiwara, Yuka Kanazawa

  • 1Division of Cerebrovascular Medicine, Kyushu Rosai Hospital.

Rinsho Shinkeigaku = Clinical Neurology
|June 20, 2014
PubMed

Insights

This study highlights ANCA-associated vasculitis (AAV) as a cause of recurrent strokes and fever of unknown origin. Early diagnosis and steroid treatment can prevent further neurological events.

Area of Science:

  • Neurology
  • Rheumatology
  • Immunology

Background:

  • A 73-year-old male with a history of hypertension and strokes presented with decreased spontaneity.
  • Initial brain MRI revealed acute infarctions in the right caudate nucleus and left putamen.

Observation:

  • The patient developed a low-grade fever and severe inflammatory reaction unresponsive to antibiotics.
  • New multiple infarctions appeared on follow-up MRI, alongside right hemiparesis.

Findings:

  • High MPO-ANCA titer (57 EU) led to the diagnosis of ANCA-associated vasculitis (AAV).
  • Steroid therapy effectively managed the inflammatory reaction and prevented recurrent strokes.

Implications:

  • ANCA-associated vasculitis should be considered in cases of recurrent small infarctions with unexplained fever.
  • This diagnosis is particularly relevant for lesions in perforating artery territories.

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