Atormac
Neurology India
Open access journal indexed with Index Medicus
  Users online: 325  
 Home | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (775 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed47    
    Printed0    
    Emailed0    
    PDF Downloaded5    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
NEUROIMAGES
Year : 2018  |  Volume : 66  |  Issue : 6  |  Page : 1843-1844

A probable cerebral angiitis after allogeneic bone marrow transplantation


Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China

Date of Web Publication28-Nov-2018

Correspondence Address:
Dr. Long Yin
Department of Neurosurgery, Tianjin Huanhu Hospital, No. 6 Jizhao Road, Jinnan District, Tianjin 300350
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.246260

Rights and Permissions



How to cite this article:
Ren H, Ma L, Yu M, Wei M, Yin L. A probable cerebral angiitis after allogeneic bone marrow transplantation. Neurol India 2018;66:1843-4

How to cite this URL:
Ren H, Ma L, Yu M, Wei M, Yin L. A probable cerebral angiitis after allogeneic bone marrow transplantation. Neurol India [serial online] 2018 [cited 2018 Dec 11];66:1843-4. Available from: http://www.neurologyindia.com/text.asp?2018/66/6/1843/246260




A 24-year old man presented with lethargy, cognitive deficits, and weakness of limbs for 10 days. He had a history of acute myelogenous leukemia and an allogeneic bone marrow transplantation (BMT) had been done a year ago. Three weeks ago, he suffered an episode of generalized tonic-clonic seizure and focal cortical subarachnoid hemorrhage. One week prior to admission, he suffered from an episode of blue fingertips, which was diagnosed as vasculitis. This time, the routine brain computed tomography and magnetic resonance imaging after admission were nonspecific. A relapse in his leukemia or the presence of central nervous system infiltration of the tumor was excluded by the hematologists. Considering the history of subarachnoid hemorrhage, a cerebral angiography was performed. The results comprehensively showed that multiple segments of abnormally dilated and narrowed distal branches of cerebral arteries were present; and, there were no stenoses in the main trunks of the internal carotid artery and the vertebro-basilar artery [Figure 1]. These results suggested the presence of vasculitis of the cerebral arteries. The erythrocytic sedimentation rate, C-reactive protein level, and investigations for infectious causes such as cytomegalovirus were normal or negative. Steroids were then administrated and the patient gradually improved.
Figure 1: Cerebral angiography showing multiple segments of abnormally dilated and narrowed branches of cerebral arteries, suggesting a vasculitis. The dilated segments of vessels appeared distended beyond their expected normal caliber. (a and b) Injection of the right internal carotid artery (ICA). (c and d) Injection of the left ICA. (e and f) Injection of the vertebral artery

Click here to view


Vasculitis after BMT is known to be caused by viruses such as cytomegalovirus (CMV), and cerebral vessels can also be involved.[1] Other causes of cerebral angiitis include cerebral angiopathy of other etiologies, cyclosporine neurotoxicity, leukoencephalopathy due to intrathecal methotrexate administration, or irradiation. Vasculitis associated with chronic graft-versus-host disease (GVHD) should also be taken into consideration.[1] The pathological features could be described as parenchymal lymphocytic inflammation, microglia activation, and cerebral angiitis-like changes.[2] Regarding our case with blue fingertips and no evidence of an underlying infectious focus, we suspect that the most likely cause of the angiitis-like angiographic image might have been a be a chronic GVHD. There is a reported patient whose manifestations were quite similar to that of our case.[3] However, the definite diagnosis requires a biopsy and the assessment of an autoimmune panel including the cluster of differentiation (CD) 11a and C-C chemokine receptor type 5 (CCR5).[4]

Ethical approval was obtained from the Human Research Ethics Committee of Tianjin Huanhu Hospital and the patient consent was obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Takatsuka H, Okamoto T, Yamada S, Fujimori Y, Tamura S, Wada H, et al. New imaging findings in a patient with central nervous system dysfunction after bone marrow transplantation. Acta Haematol 2000;103:203-5.  Back to cited text no. 1
    
2.
Padovan CS, Gerbitz A, Sostak P, Holler E, Ferrara JL, Bise K, et al. Cerebral involvement in graft-versus-host disease after murine bone marrow transplantation. Neurology 2001;56:1106-8.  Back to cited text no. 2
    
3.
Campbell JN, Morris PP. Cerebral vasculitis in graft-versus-host disease: A case report. AJNR Am J Neuroradiol 2005;26:654-6.  Back to cited text no. 3
    
4.
Sostak P, Padovan CS, Eigenbrod S, Roeber S, Segerer S, Schankin C, et al. Cerebral angiitis in four patients with chronic GVHD. Bone Marrow Transplant 2010;45:1181-8.  Back to cited text no. 4
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow