Neuroradiologic findings in polyarteritis nodosa

Area of Science:

• Neurology
• Radiology
• Rheumatology

Background:

• Polyarteritis nodosa (PAN) is a systemic vasculitis affecting medium-sized arteries.
• Neurologic manifestations in PAN can be diverse and challenging to diagnose.
• Understanding neuroradiologic findings is crucial for timely diagnosis and management of PAN.

Purpose of the Study:

• To elucidate the characteristic neuroradiologic findings in patients diagnosed with polyarteritis nodosa.
• To correlate imaging findings with clinical presentation and potential underlying mechanisms of cerebral infarction in PAN.

Main Methods:

• Retrospective review of hospital records over a 10-year period.
• Analysis of neuroimaging studies (CT, MRI, cerebral angiography) in 50 patients with polyarteritis nodosa.
• Detailed examination of imaging findings in 5 patients with abnormal neuroimaging results.

Main Results:

• All 5 patients exhibited abnormalities on CT scans; 3 had abnormal MRI findings, and 1 showed an abnormal cerebral angiogram.
• Cerebral cortical or subcortical infarctions were present in all patients, with one case also showing brainstem and cerebellar infarctions.
• Evidence of arteritis was observed in one patient's angiogram, with probable/possible arteritis in three others. Left ventricular dysfunction was noted in three patients.

Conclusions:

• Small peripheral cerebral infarctions, indicative of arteritis affecting medium and small arteries, are the predominant neuroradiologic finding in PAN.
• Cardiogenic embolism secondary to left ventricular dysfunction should be considered a significant cause of cerebral infarction in PAN patients.
• Multimodality neuroimaging plays a vital role in diagnosing and characterizing cerebrovascular complications of polyarteritis nodosa.