Neurology · MU Sofia

85. Vasculitis and vasculopathy

Covers vasculitis, inflammation of blood vessel walls leading to stenosis, occlusion and ischaemia, and vasculopathy, non-inflammatory vessel disease. Vasculitis is classified by vessel size and its neurological features, mononeuritis multiplex, CNS angiitis, diagnosis and treatment are set out. Vasculopathy types such as atherosclerotic, hypertensive, diabetic and cerebral amyloid angiopathy are listed, ending with a table contrasting the two conditions.

Inside: 1 section · 1 table · 15 flashcards · 2 min

Topic 85 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 253 words (2 min of reading), with 15 flashcards.

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  1. Vasculitis and vasculopathy

Vasculitis and vasculopathy

Definition

Vasculitis

  • Vasculitis is inflammation of blood vessel walls causing: Vessel wall damage. Stenosis or occlusion. Ischemia and infarction of tissues, including the nervous system

Vasculopathy: Vasculopathy refers to non-inflammatory diseases of blood vessels causing vascular dysfunction, thrombosis, or occlusion.

1. Vasculitis

Classification

1.Large-Vessel Vasculitis: Giant Cell Arteritis. Takayasu Arteritis

2.Medium-Vessel Vasculitis: Polyarteritis Nodosa

3.Small-Vessel Vasculitis:

  • ANCA-associated vasculitis: Granulomatosis with Polyangiitis. Microscopic Polyangiitis
  • Immune-complex vasculitis

Neurological Manifestations of Vasculitis

  • Central Nervous System: Ischemic stroke. Transient ischemic attacks (TIA). Headache. Seizures. Cognitive dysfunction. Encephalopathy
  • Peripheral Nervous System: Mononeuritis multiplex (most characteristic). Sensorimotor polyneuropathy

Mononeuritis Multiplex

Definition: Asymmetric involvement of multiple peripheral nerves due to ischemic nerve injury.

Features: Acute/subacute onset. Painful neuropathy. Asymmetrical weakness. Sensory loss

Primary Angiitis of the CNS (PACNS)

Features: Headache. Stroke-like episodes. Cognitive decline. Seizures.

Diagnosis: MRI abnormalities. Angiography. Brain biopsy (gold standard)

Diagnosis of Vasculitis

  • Laboratory Findings: ↑ ESR and CRP. ANCA positivity (certain forms). Autoimmune markers
  • CSF: Mild inflammatory changes (CNS vasculitis)
  • Imaging: MRI brain. CT/MR angiography
  • Biopsy: Definitive diagnosis when feasible

Treatment of Vasculitis

  • First-Line: Corticosteroids
  • Severe Disease: Cyclophosphamide. Rituximab. Other immunosuppressants

2. Vasculopathy

Definition: Non-inflammatory vascular disorders affecting blood vessels.

Important Types

A. Atherosclerotic Vasculopathy: Most common. Causes ischemic stroke and TIA

B. Hypertensive Vasculopathy: Small vessel disease. Lacunar infarcts. Intracerebral hemorrhage

C. Diabetic Vasculopathy: Microvascular disease. Stroke risk increased

D. Cerebral Amyloid Angiopathy

  • Pathology: Amyloid deposition in cerebral vessels
  • Features: Lobar intracerebral hemorrhage. Elderly patients

Clinical Manifestations of Vasculopathy

  • CNS: Stroke. TIA. Vascular dementia. Intracerebral hemorrhage
  • Peripheral Nervous System: Ischemic neuropathies (less common)

Differential Diagnosis

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