Granulomatous angiitis. An unusual etiology of stroke

A 43-year-old man, who died five months after the onset of left-sided sensory deficit, had angiographical and pathological evidence of an angiitis confined largely to the distribution of the right middle cerebral artery. Histological examination identified this process to be intracranial noninfectious granulomatous angiitis. Although certain clinical and pathological features of this disorder overlap with other vasculitides which effect the central nervous system, the disease nevertheless retains sufficient individuality to warrant status as an entity, and should be considered in the differential diagnosis in adults with lesions which produce focal neurological deficits and signs of increased intracranial pressure. The definitive answer regarding an infectious etiology will come only from detailed culture studies of the affected vessels.