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Primary phlebitis of central nervous system revealed by black-blood magnetic resonance imaging

Jinsoo Koh1, Junko Taruya2, Megumi Mori2

  • 1Department of Neurology, Wakayama Medical University, Wakayama, Japan jinsoo@wakayama-med.ac.jp.

BMJ Case Reports
|October 14, 2021
PubMed

Insights

Primary phlebitis of the central nervous system (PPCNS) is a rare condition. Black-blood MRI aided diagnosis, and treatment with immunosuppressants led to symptom improvement and no recurrence.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroimmunology

Background:

  • Primary phlebitis of the central nervous system (PPCNS) is an uncommon condition, potentially a subtype of primary angiitis of the CNS.
  • Early diagnosis and treatment are crucial for managing neurological vascular disorders.

Observation:

  • A 39-year-old male presented with a two-week history of anterograde amnesia and behavioral changes.
  • Black-blood MRI revealed contrast enhancement in the left basilar vein and cerebral superficial veins.
  • Arterial angiography showed no significant abnormalities.

Findings:

  • The patient was diagnosed with PPCNS based on clinical presentation and imaging.
  • Treatment involved methylprednisolone and cyclophosphamide pulses, leading to gradual improvement in neuropsychological symptoms and MRI findings.
  • The patient's condition stabilized with a reduced prednisolone dose, showing no recurrence after two months.

Implications:

  • Black-blood MRI (BB-MRI) demonstrates potential utility as a diagnostic tool for PPCNS.
  • This case highlights the effectiveness of immunosuppressive therapy in managing PPCNS.
  • Further research into BB-MRI's role in diagnosing CNS vasculitis is warranted.
Keywords:
neuroimagingvasculitis

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