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Primary and secondary central nervous system vasculitis: clinical manifestations, laboratory findings, neuroimaging, and treatment analysis
The objectives of this study are to compare the initial clinical, laboratory, and imaging features in primary central nervous system vasculitis (PCNSV) vs secondary central nervous system vasculitis (SCNSV) and follow up after treatment with intravenous cyclophosphamide (IV-CYC) plus glucocorticoste...
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| Published in: | Clinical rheumatology 2015-04, Vol.34 (4), p.729-738 |
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| creator | Vera-Lastra, Olga Sepúlveda-Delgado, Jesús Cruz-Domínguez, María del Pilar Medina, Gabriela Casarrubias-Ramírez, Moisés Molina-Carrión, Luis E. Pineda-Galindo, Luis F. Olvera-Acevedo, Arturo Hernández-Gonzalez, Claudia Jara, Luis J. |
| description | The objectives of this study are to compare the initial clinical, laboratory, and imaging features in primary central nervous system vasculitis (PCNSV) vs secondary central nervous system vasculitis (SCNSV) and follow up after treatment with intravenous cyclophosphamide (IV-CYC) plus glucocorticosteroids (GCS): methylprednisolone (MP). Neurological, laboratory, and neuroimaging findings were analyzed in PCNSV and SCNSV patients. Cerebral biopsy (CB) was performed in nine patients. Both groups received at onset MP plus IV-CYC for 6 months, followed by bimonthly IV-CYC plus prednisone (PND) for 12 months. All patients were followed during 36 months. Thirty patients were included (12 PCNSV and 18 SCNSV). Focal and non-focal neurological manifestations were similar in both groups, headache being the most frequent manifestation in both groups. Fatigue, myalgias, arthralgias, neuropathy, low leukocytes and platelets, elevated erythrocyte sedimentation rate, positive antinuclear antibodies (ANA), anti-double-stranded DNA (dsDNA), antineutrophil cytoplasmic antibodies (ANCA), low complement, and rheumatoid factor were more frequent in SCNSV (
p
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| doi_str_mv | 10.1007/s10067-014-2831-8 |
| format | article |
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p
< 0.05). In cerebrospinal fluid, pleocytosis and proteins were higher in PCNSV (
p
< 0.05). Periventricular and subcortical hyperintense lesions were observed in cranial magnetic resonance imaging in both vasculitides. Cerebral angiography and angioresonance showed narrowing of vasculature in all patients in both groups. CB showed gliosis and lymphocytic infiltration within and around the walls in four patients and granulomatous infiltration in the other patients. After treatment, the Kaplan-Meier survival curve showed a higher relapse-free survival in PCNSV (
p
< 0.05). Neurological manifestations and neuroimaging findings were similar in both groups of vasculitides, but general symptoms, joint, musculoskeletal, and peripheral neuropathy were preponderant in SCNSV. After treatment with IV-CYC and GCS, patients with PCNSV had a higher relapse-free survival than those with SCNSV.</description><identifier>ISSN: 0770-3198</identifier><identifier>EISSN: 1434-9949</identifier><identifier>DOI: 10.1007/s10067-014-2831-8</identifier><identifier>PMID: 25425493</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Adult ; Biopsy ; Cerebral Angiography ; Cyclophosphamide - administration & dosage ; Disease-Free Survival ; Female ; Follow-Up Studies ; Headache ; Humans ; Kaplan-Meier Estimate ; Magnetic Resonance Imaging ; Male ; Medicine ; Medicine & Public Health ; Methylprednisolone - administration & dosage ; Middle Aged ; Neuroimaging ; Original Article ; Prednisone - administration & dosage ; Recurrence ; Rheumatology ; Vasculitis - diagnosis ; Vasculitis, Central Nervous System - diagnosis</subject><ispartof>Clinical rheumatology, 2015-04, Vol.34 (4), p.729-738</ispartof><rights>International League of Associations for Rheumatology (ILAR) 2014</rights><rights>International League of Associations for Rheumatology (ILAR) 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-fde748607e246403a7a39f5582a1d1713af2d0cd15aa7e9c153771ca9191297e3</citedby><cites>FETCH-LOGICAL-c508t-fde748607e246403a7a39f5582a1d1713af2d0cd15aa7e9c153771ca9191297e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25425493$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vera-Lastra, Olga</creatorcontrib><creatorcontrib>Sepúlveda-Delgado, Jesús</creatorcontrib><creatorcontrib>Cruz-Domínguez, María del Pilar</creatorcontrib><creatorcontrib>Medina, Gabriela</creatorcontrib><creatorcontrib>Casarrubias-Ramírez, Moisés</creatorcontrib><creatorcontrib>Molina-Carrión, Luis E.</creatorcontrib><creatorcontrib>Pineda-Galindo, Luis F.</creatorcontrib><creatorcontrib>Olvera-Acevedo, Arturo</creatorcontrib><creatorcontrib>Hernández-Gonzalez, Claudia</creatorcontrib><creatorcontrib>Jara, Luis J.</creatorcontrib><title>Primary and secondary central nervous system vasculitis: clinical manifestations, laboratory findings, neuroimaging, and treatment analysis</title><title>Clinical rheumatology</title><addtitle>Clin Rheumatol</addtitle><addtitle>Clin Rheumatol</addtitle><description>The objectives of this study are to compare the initial clinical, laboratory, and imaging features in primary central nervous system vasculitis (PCNSV) vs secondary central nervous system vasculitis (SCNSV) and follow up after treatment with intravenous cyclophosphamide (IV-CYC) plus glucocorticosteroids (GCS): methylprednisolone (MP). Neurological, laboratory, and neuroimaging findings were analyzed in PCNSV and SCNSV patients. Cerebral biopsy (CB) was performed in nine patients. Both groups received at onset MP plus IV-CYC for 6 months, followed by bimonthly IV-CYC plus prednisone (PND) for 12 months. All patients were followed during 36 months. Thirty patients were included (12 PCNSV and 18 SCNSV). Focal and non-focal neurological manifestations were similar in both groups, headache being the most frequent manifestation in both groups. Fatigue, myalgias, arthralgias, neuropathy, low leukocytes and platelets, elevated erythrocyte sedimentation rate, positive antinuclear antibodies (ANA), anti-double-stranded DNA (dsDNA), antineutrophil cytoplasmic antibodies (ANCA), low complement, and rheumatoid factor were more frequent in SCNSV (
p
< 0.05). In cerebrospinal fluid, pleocytosis and proteins were higher in PCNSV (
p
< 0.05). Periventricular and subcortical hyperintense lesions were observed in cranial magnetic resonance imaging in both vasculitides. Cerebral angiography and angioresonance showed narrowing of vasculature in all patients in both groups. CB showed gliosis and lymphocytic infiltration within and around the walls in four patients and granulomatous infiltration in the other patients. After treatment, the Kaplan-Meier survival curve showed a higher relapse-free survival in PCNSV (
p
< 0.05). Neurological manifestations and neuroimaging findings were similar in both groups of vasculitides, but general symptoms, joint, musculoskeletal, and peripheral neuropathy were preponderant in SCNSV. After treatment with IV-CYC and GCS, patients with PCNSV had a higher relapse-free survival than those with SCNSV.</description><subject>Adult</subject><subject>Biopsy</subject><subject>Cerebral Angiography</subject><subject>Cyclophosphamide - administration & dosage</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Headache</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Methylprednisolone - administration & dosage</subject><subject>Middle Aged</subject><subject>Neuroimaging</subject><subject>Original Article</subject><subject>Prednisone - administration & dosage</subject><subject>Recurrence</subject><subject>Rheumatology</subject><subject>Vasculitis - diagnosis</subject><subject>Vasculitis, Central Nervous System - diagnosis</subject><issn>0770-3198</issn><issn>1434-9949</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNp1kcFqFTEUhoMo9rb6AG5kwI2LjuZMMpPEnRSrQkEXug6nmcwlZSapOZnCfQZf2txOFRGEkHCS7_x_kp-xF8DfAOfqLdV5UC0H2XZaQKsfsR1IIVtjpHnMdlwp3gow-oSdEt1wzjtt4Ck76XpZhxE79vNrDgvmQ4NxbMi7FMdj5XwsGecm-nyXVmroQMUvzR2SW-dQAr1r3BxicJVZMIbJU8ESUqTzZsbrlLGkKjOFOIa4r5vRrzlVp30tz-_NSvZYlupTK5wPFOgZezLhTP75w3rGvl9--Hbxqb368vHzxfur1vVcl3YavZJ64Mp3cpBcoEJhpr7XHcIICgRO3cjdCD2i8sZBL5QChwYMdEZ5ccZeb7q3Of1Y683tEsj5ecbo62MtDEMPoLmUFX31D3qT1lzve09JybnsjhRslMuJKPvJ3m6_aoHbY1J2S8rWpOwxKatrz8sH5fV68eOfjt_RVKDbAKpHce_zX9b_Vf0FHM-gog</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Vera-Lastra, Olga</creator><creator>Sepúlveda-Delgado, Jesús</creator><creator>Cruz-Domínguez, María del Pilar</creator><creator>Medina, Gabriela</creator><creator>Casarrubias-Ramírez, Moisés</creator><creator>Molina-Carrión, Luis E.</creator><creator>Pineda-Galindo, Luis F.</creator><creator>Olvera-Acevedo, Arturo</creator><creator>Hernández-Gonzalez, Claudia</creator><creator>Jara, Luis J.</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20150401</creationdate><title>Primary and secondary central nervous system vasculitis: clinical manifestations, laboratory findings, neuroimaging, and treatment analysis</title><author>Vera-Lastra, Olga ; 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Neurological, laboratory, and neuroimaging findings were analyzed in PCNSV and SCNSV patients. Cerebral biopsy (CB) was performed in nine patients. Both groups received at onset MP plus IV-CYC for 6 months, followed by bimonthly IV-CYC plus prednisone (PND) for 12 months. All patients were followed during 36 months. Thirty patients were included (12 PCNSV and 18 SCNSV). Focal and non-focal neurological manifestations were similar in both groups, headache being the most frequent manifestation in both groups. Fatigue, myalgias, arthralgias, neuropathy, low leukocytes and platelets, elevated erythrocyte sedimentation rate, positive antinuclear antibodies (ANA), anti-double-stranded DNA (dsDNA), antineutrophil cytoplasmic antibodies (ANCA), low complement, and rheumatoid factor were more frequent in SCNSV (
p
< 0.05). In cerebrospinal fluid, pleocytosis and proteins were higher in PCNSV (
p
< 0.05). Periventricular and subcortical hyperintense lesions were observed in cranial magnetic resonance imaging in both vasculitides. Cerebral angiography and angioresonance showed narrowing of vasculature in all patients in both groups. CB showed gliosis and lymphocytic infiltration within and around the walls in four patients and granulomatous infiltration in the other patients. After treatment, the Kaplan-Meier survival curve showed a higher relapse-free survival in PCNSV (
p
< 0.05). Neurological manifestations and neuroimaging findings were similar in both groups of vasculitides, but general symptoms, joint, musculoskeletal, and peripheral neuropathy were preponderant in SCNSV. After treatment with IV-CYC and GCS, patients with PCNSV had a higher relapse-free survival than those with SCNSV.</abstract><cop>London</cop><pub>Springer London</pub><pmid>25425493</pmid><doi>10.1007/s10067-014-2831-8</doi><tpages>10</tpages></addata></record> |
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| subjects | Adult Biopsy Cerebral Angiography Cyclophosphamide - administration & dosage Disease-Free Survival Female Follow-Up Studies Headache Humans Kaplan-Meier Estimate Magnetic Resonance Imaging Male Medicine Medicine & Public Health Methylprednisolone - administration & dosage Middle Aged Neuroimaging Original Article Prednisone - administration & dosage Recurrence Rheumatology Vasculitis - diagnosis Vasculitis, Central Nervous System - diagnosis |
| title | Primary and secondary central nervous system vasculitis: clinical manifestations, laboratory findings, neuroimaging, and treatment analysis |
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