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[PMID]:28471627
[Au] Autor:Anis S; Sharabi A; Mina Y; Klein A; Cagnano E; Elkayam O; Gurevich T
[Ad] Endereço:Department of Neurology, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
[Ti] Título:Rituximab as a Second-Line Treatment for Lymphocytic Vasculitis of the Central Nervous System.
[So] Source:Isr Med Assoc J;18(10):630-632, 2016 Oct.
[Is] ISSN:1565-1088
[Cp] País de publicação:Israel
[La] Idioma:eng
[Mh] Termos MeSH primário: Fatores Imunológicos/uso terapêutico
Rituximab/uso terapêutico
Vasculite do Sistema Nervoso Central/tratamento farmacológico
[Mh] Termos MeSH secundário: Seguimentos
Seres Humanos
Masculino
Meia-Idade
Resultado do Tratamento
Vasculite do Sistema Nervoso Central/diagnóstico
Vasculite do Sistema Nervoso Central/fisiopatologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Immunologic Factors); 4F4X42SYQ6 (Rituximab)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE


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[PMID]:29030476
[Au] Autor:Mossa-Basha M; Shibata DK; Hallam DK; de Havenon A; Hippe DS; Becker KJ; Tirschwell DL; Hatsukami T; Balu N; Yuan C
[Ad] Endereço:From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.). mmossab@uw.edu.
[Ti] Título:Added Value of Vessel Wall Magnetic Resonance Imaging for Differentiation of Nonocclusive Intracranial Vasculopathies.
[So] Source:Stroke;48(11):3026-3033, 2017 Nov.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Our goal is to determine the added value of intracranial vessel wall magnetic resonance imaging (IVWI) in differentiating nonocclusive vasculopathies compared with luminal imaging alone. METHODS: We retrospectively reviewed images from patients with both luminal and IVWI to identify cases with clinically defined intracranial vasculopathies: atherosclerosis (intracranial atherosclerotic disease), reversible cerebral vasoconstriction syndrome, and inflammatory vasculopathy. Two neuroradiologists blinded to clinical data reviewed the luminal imaging of defined luminal stenoses/irregularities and evaluated the pattern of involvement to make a presumed diagnosis with diagnostic confidence. Six weeks later, the 2 raters rereviewed the luminal imaging in addition to IVWI for the pattern of wall involvement, presence and pattern of postcontrast enhancement, and presumed diagnosis and confidence. Analysis was performed on per-lesion and per-patient bases. RESULTS: Thirty intracranial atherosclerotic disease, 12 inflammatory vasculopathies, and 12 reversible cerebral vasoconstriction syndrome patients with 201 lesions (90 intracranial atherosclerotic disease, 64 reversible cerebral vasoconstriction syndrome, and 47 inflammatory vasculopathy lesions) were included. For both per-lesion and per-patient analyses, there was significant diagnostic accuracy improvement with luminal imaging+IVWI when compared with luminal imaging alone (per-lesion: 88.8% versus 36.1%; <0.001 and per-patient: 96.3% versus 43.5%; <0.001, respectively). There was substantial interrater diagnostic agreement for luminal imaging+IVWI (κ=0.72) and only slight agreement for luminal imaging (κ=0.04). Although there was a significant correlation for both luminal and IVWI pattern of wall involvement with diagnosis, there was a stronger correlation for IVWI finding of lesion eccentricity and intracranial atherosclerotic disease diagnosis than for luminal imaging (κ=0.69 versus 0.18; <0.001). CONCLUSIONS: IVWI can significantly improve the differentiation of nonocclusive intracranial vasculopathies when combined with traditional luminal imaging modalities.
[Mh] Termos MeSH primário: Arteriosclerose Intracraniana/diagnóstico por imagem
Angiografia por Ressonância Magnética/métodos
Vasculite do Sistema Nervoso Central/diagnóstico por imagem
Vasoespasmo Intracraniano/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171015
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.018227


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[PMID]:28809763
[Au] Autor:Lenassi E; Kojovic M; Jaki Mekjavic P; Sega S; Vidovic Valentincic N
[Ad] Endereço:Eye Hospital (EL, PJM, NVV), University Medical Centre, Ljubljana, Slovenia; and Department of Neurology (MK, SS), University Medical Centre, Ljubljana, Slovenia.
[Ti] Título:Persistent Placoid Maculopathy Complicated by Cerebral Vasculitis.
[So] Source:J Neuroophthalmol;37(3):273-275, 2017 Sep.
[Is] ISSN:1536-5166
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Persistent placoid maculopathy (PPM) is a bilateral inflammatory chorioretinopathy characterized by long-standing plaque-like macular lesions. No systemic manifestations have been reported to date. We describe a case of PPM complicated by cerebral vasculitis, suggesting that neurological symptoms, including headache, should be enquired about in all PPM subjects.
[Mh] Termos MeSH primário: Macula Lutea/patologia
Doenças Retinianas/etiologia
Vasculite do Sistema Nervoso Central/complicações
Acuidade Visual
[Mh] Termos MeSH secundário: Encéfalo/patologia
Feminino
Angiofluoresceinografia
Fundo de Olho
Seres Humanos
Imagem por Ressonância Magnética
Meia-Idade
Doenças Retinianas/diagnóstico
Tomografia de Coerência Óptica
Vasculite do Sistema Nervoso Central/diagnóstico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170816
[St] Status:MEDLINE
[do] DOI:10.1097/WNO.0000000000000399


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[PMID]:28804113
[Au] Autor:Takahashi K; Sato H; Hattori H; Takao M; Takahashi S; Suzuki N
[Ad] Endereço:Department of Neurology, Saitama Municipal Hospital.
[Ti] Título:Case report of a 28-year-old male with the rapid progression of steroid-resistant central nervous system vasculitis diagnosed by a brain biopsy.
[So] Source:Rinsho Shinkeigaku;57(9):509-514, 2017 09 30.
[Is] ISSN:1882-0654
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:A 28-year-old Japanese male without a significant past medical history presented with new-onset generalized clonic seizure and headache. A brain MRI revealed multiple enhanced lesions on both cerebral hemispheres. Laboratory exams showed no evidence of systemic inflammation or auto-immune antibodies such as ANCAs. Despite four courses of high-dose methylprednisolone pulse therapy and five treatments with plasmapheresis, his symptoms worsened and the MRI lesions progressed rapidly. During these treatments, we performed a targeted brain biopsy, that revealed histological findings consistent with a predominant angiitis of parenchymal and subdural small vessels. He was provided with diagnosis of central nervous system vasculitis (CNSV). Subsequent cyclophosphamide pulse therapy enabled a progressive successful improvement of his symptoms. While diagnostic methods for CNSV remain controversial, histological findings are thought to be more useful in obtaining a more definitive diagnosis than findings in image studies, such as MRI and angiography. We suggest that a brain biopsy should be considered during the early period of cases with suspected CNSV and rapid clinical deterioration. We also detected human herpesvirus 7 (HHV-7) using PCR technology in brain biopsy specimens, however the relationship between CNSV and HHV-7 infection is unknow.
[Mh] Termos MeSH primário: Biópsia
Encéfalo/patologia
Vasculite do Sistema Nervoso Central/diagnóstico
Vasculite do Sistema Nervoso Central/patologia
[Mh] Termos MeSH secundário: Adulto
Encéfalo/virologia
Ciclofosfamida/administração & dosagem
Imagem de Difusão por Ressonância Magnética
Progressão da Doença
Quimioterapia Combinada
Herpesvirus Humano 7/isolamento & purificação
Seres Humanos
Masculino
Metilprednisolona/administração & dosagem
Troca Plasmática
Prednisolona/administração & dosagem
Pulsoterapia
Resultado do Tratamento
Vasculite do Sistema Nervoso Central/terapia
Vasculite do Sistema Nervoso Central/virologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
8N3DW7272P (Cyclophosphamide); 9PHQ9Y1OLM (Prednisolone); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE
[do] DOI:10.5692/clinicalneurol.cn-001034


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[PMID]:28705900
[Au] Autor:Schuster S; Bachmann H; Thom V; Kaufmann-Buehler AK; Matschke J; Siemonsen S; Glatzel M; Fiehler J; Gerloff C; Magnus T; Thomalla G
[Ad] Endereço:Department of Neurology, University Hospital Hamburg-Eppendorf, Germany.
[Ti] Título:Subtypes of primary angiitis of the CNS identified by MRI patterns reflect the size of affected vessels.
[So] Source:J Neurol Neurosurg Psychiatry;88(9):749-755, 2017 Sep.
[Is] ISSN:1468-330X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To describe patterns of diagnostic findings, and identify subgroups of primary angiitis of the central nervous system (PACNS). METHODS: We retrospectively analysed 31 patients with PACNS. Cases were selected by predetermined diagnostic criteria and stratified into biopsy-proven and imaging-based PACNS. We compared clinical characteristics, cerebrospinal fluid (CSF) findings and imaging results including high-resolution vessel wall MRI between groups. RESULTS: There were 31 cases of PACNS (mean age 45.6 years, 58.1% female), of whom 17 (55%) were biopsy-proven, 14 (45%) were based on imaging findings. Patients with a positive biopsy had fewer infarcts (29.4% vs 85.7%, p=0.003), were more likely to have meningeal and parenchymal contrast enhancement (76.5% vs 28.6%, p=0.012), were less likely to have abnormal MR angiography (11.8% vs 100%, p<0.001) and did not show vessel wall enhancement at the time of diagnosis (0% vs 76.9%, p<0.001). In contrast, patients with imaging-based diagnosis showed more frequently multiple infarcts and vessel abnormalities, with vessel wall enhancement in most of the cases. Clinical characteristics and CSF analysis did not reveal marked differences between groups. INTERPRETATION: Multi-parametric MRI distinguishes two subtypes of PACNS that most likely differ concerning the affected vessel size. Biopsy-proven PACNS primarily involves smaller vessels beyond the resolution of vascular imaging, while imaging-based PACNS affects predominantly medium-sized vessels leading to false-negative biopsy results. Using distinct MRI patterns may be helpful for selecting patients for appropriate invasive diagnostic modalities.
[Mh] Termos MeSH primário: Encéfalo/patologia
Imagem por Ressonância Magnética
Vasculite do Sistema Nervoso Central/classificação
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Angiografia por Ressonância Magnética
Masculino
Meia-Idade
Estudos Retrospectivos
Vasculite do Sistema Nervoso Central/líquido cefalorraquidiano
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171114
[Lr] Data última revisão:
171114
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE
[do] DOI:10.1136/jnnp-2017-315691


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[PMID]:28667559
[Au] Autor:Bougea A; Spantideas N
[Ad] Endereço:Department of Neurology, University of Athens Medical School, Aeginition Hospital, Athens, Greece. annita139@yahoo.gr.
[Ti] Título:Vasculitis in the Central Nervous System.
[So] Source:Adv Exp Med Biol;1003:173-185, 2017.
[Is] ISSN:0065-2598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Central nervous system (CNS) vasculitides are a heterogeneous group of disorders characterized by an inflammatory cell infiltration and necrosis of blood vessel walls in the brain, spinal cord, and the meninges. The CNS complications are likely to be fatal without judicious use of immunosuppression; thus, early diagnosis may prevent from damage and disability. This chapter updates our knowledge on CNS vasculitis-related immunological mechanisms, neurological complications, diagnosis, and management.
[Mh] Termos MeSH primário: Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia
Artérias Cerebrais/imunologia
Vasculite do Sistema Nervoso Central/imunologia
[Mh] Termos MeSH secundário: Animais
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/metabolismo
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/patologia
Anticorpos Anticitoplasma de Neutrófilos/imunologia
Anticorpos Anticitoplasma de Neutrófilos/metabolismo
Complexo Antígeno-Anticorpo/imunologia
Complexo Antígeno-Anticorpo/metabolismo
Artérias Cerebrais/metabolismo
Artérias Cerebrais/patologia
Citocinas/imunologia
Citocinas/metabolismo
Seres Humanos
Macrófagos/imunologia
Macrófagos/metabolismo
Transdução de Sinais
Linfócitos T Citotóxicos/imunologia
Linfócitos T Citotóxicos/metabolismo
Vasculite do Sistema Nervoso Central/metabolismo
Vasculite do Sistema Nervoso Central/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Antigen-Antibody Complex); 0 (Cytokines)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170702
[St] Status:MEDLINE
[do] DOI:10.1007/978-3-319-57613-8_9


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[PMID]:28398199
[Au] Autor:Nittner-Marszalska M; Kowal A; Szewczyk P; Guranski K; Ejma M
[Ad] Endereço:Department of Internal Diseases and Allergology, Wroclaw Medical University, Wroclaw, Poland.
[Ti] Título:Wasp Venom Immunotherapy in a Patient With Immune-Mediated Inflammatory Central Nervous System Disease: Is it Safe?
[So] Source:J Investig Allergol Clin Immunol;27(2):127-129, 2017.
[Is] ISSN:1018-9068
[Cp] País de publicação:Spain
[La] Idioma:eng
[Mh] Termos MeSH primário: Anafilaxia/terapia
Dessensibilização Imunológica/métodos
Mordeduras e Picadas de Insetos/terapia
Vasculite do Sistema Nervoso Central/complicações
Venenos de Vespas/administração & dosagem
Vespas/imunologia
[Mh] Termos MeSH secundário: Anafilaxia/diagnóstico
Anafilaxia/imunologia
Animais
Dessensibilização Imunológica/efeitos adversos
Avaliação da Deficiência
Feminino
Seres Humanos
Mordeduras e Picadas de Insetos/diagnóstico
Mordeduras e Picadas de Insetos/imunologia
Imagem por Ressonância Magnética
Meia-Idade
Segurança do Paciente
Fatores de Risco
Resultado do Tratamento
Vasculite do Sistema Nervoso Central/diagnóstico
Vasculite do Sistema Nervoso Central/tratamento farmacológico
Vasculite do Sistema Nervoso Central/imunologia
Venenos de Vespas/efeitos adversos
Venenos de Vespas/imunologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Wasp Venoms)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170613
[Lr] Data última revisão:
170613
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.18176/jiaci.0126


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[PMID]:28375836
[Au] Autor:Walsh S; Knöfler R; Hahn G; Lohse J; Berner R; Brenner S; Smitka M; von der Hagen M; Hedrich CM
[Ad] Endereço:Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Germany.
[Ti] Título:Childhood primary large vessel CNS vasculitis: single-centre experience and review of the literature.
[So] Source:Clin Exp Rheumatol;35 Suppl 103(1):213-220, 2017 Mar-Apr.
[Is] ISSN:0392-856X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:Ischaemic brain injuries are rare conditions in the paediatric age group. Main causes include non-arteriosclerotic arteriopathies, which in childhood usually result from primary vasculitis of large or small vessels and lead to impaired perfusion and subsequent ischaemic brain lesions. In accordance with the nomenclature of systemic forms, CNS vasculitis is subdivided into groups, based on the size of affected vessels: angiography-positive primary angiitis of medium-sized and large vessels (pPACNS), and angiography-negative angiitis of small vessels (svPACNS). We report the clinical presentation, diagnostic approach, and therapy of four children with progressive pPACNS. Patients were treated with high-dose corticosteroids and anticoagulation with unfractionated heparin in the acute phase, followed by immune modulatory treatment with mycophenolate mofetil (MMF) and dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. In this manuscript, we illustrate the experience gained in our hospital, resulting in significantly faster diagnosis and treatment initiation, and discuss the applied immune modulating treatment regimen in the context of the literature. Based on our observations, we conclude that immune modulating therapy with initial high-dose corticosteroids, followed by steroid-sparing maintenance treatment with MMF, may be safe and effective in childhood progressive pPACNS.
[Mh] Termos MeSH primário: Corticosteroides/administração & dosagem
Isquemia Encefálica/tratamento farmacológico
Imunossupressores/administração & dosagem
Ácido Micofenólico/administração & dosagem
Vasculite do Sistema Nervoso Central/tratamento farmacológico
[Mh] Termos MeSH secundário: Idade de Início
Anticoagulantes/administração & dosagem
Aspirina/administração & dosagem
Isquemia Encefálica/diagnóstico por imagem
Isquemia Encefálica/etiologia
Angiografia Cerebral/métodos
Criança
Pré-Escolar
Imagem de Difusão por Ressonância Magnética
Quimioterapia Combinada
Feminino
Alemanha
Heparina/administração & dosagem
Seres Humanos
Angiografia por Ressonância Magnética
Masculino
Inibidores da Agregação de Plaquetas/administração & dosagem
Ticlopidina/administração & dosagem
Ticlopidina/análogos & derivados
Fatores de Tempo
Resultado do Tratamento
Vasculite do Sistema Nervoso Central/complicações
Vasculite do Sistema Nervoso Central/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Anticoagulants); 0 (Immunosuppressive Agents); 0 (Platelet Aggregation Inhibitors); 9005-49-6 (Heparin); A74586SNO7 (clopidogrel); HU9DX48N0T (Mycophenolic Acid); OM90ZUW7M1 (Ticlopidine); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE


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[PMID]:28355722
[Au] Autor:Peng LJ; Qian HR; Mao LL; Xia DY; Qi XK
[Ad] Endereço:Department of Neurology, Navy General Hospital, Beijing 100048, China.
[Ti] Título:[A clinical analysis of 5 patients with infratentorial primary angiitis of central nervous system].
[So] Source:Zhonghua Nei Ke Za Zhi;56(4):284-289, 2017 Apr 01.
[Is] ISSN:0578-1426
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To explore the clinical characteristics of infratentorial primary angiitis in central nervous system(PACNS). A total of 5 cases diagnosed as infratentorial PACNS in the neurology department of Navy General Hospital of PLA in 2015 were enrolled in the study. The clinical, imaging and pathological data were collected and analyzed. All the 5 cases were male with the median onset age of thirty-four. Five cases presented with dizziness, two with headache, three with walking unstable, two with facial numbness and one with dysarthria. Rising pressure of cerebrospinal fluid (CSF) (190-245 cmH(2)O, 1 cmH(2)O=0.098 kPa) was found in 4 cases by the lumbar puncture, mildly increased number of leukocyte in 2 cases [(12-28)×10(6)/L], increased CSF protein in 3 cases(540-979 mg/L) and increased IgG index in 3 cases(0.84-1.45). Pons lesions were revealed by magnetic resonance imaging(MRI)in 4 cases, brachium pontis lesions in 2 cases, cerebellum lesions in 2 cases, one with midbrain lesion in 1 case, unilateral lesions in 4 cases and bilateral lesion in 1 case. Different degree of edema and mass effect were shown in all lesions by MRI. Patch like enhancement was found by contrast MRI in 5 cases and meningeal enhancement in 2 cases. Elevation of choline(Cho)peak was found by magnetic resonance spectroscopy(MRS)in 4 cases, reduction of N-acetyl aspartate(NAA) peak in 3 cases, appearance of lactate peak in 1 case and lipid peak in another case. Arterial spin labeling(ASL) was performed in 4 cases and no hyperperfusion was found. Susceptibility weighted imaging(SWI) was performed in 3 cases and microhemorrhage in the lesions was found in 2 cases and normal in 1 case. Magnetic resonance arteriography(MRA) was performed in 1 case and no stenosis was found. Digital subtraction arteriography(DSA) was performed in 1 case and multiple stenosis of the intracranial arteries was showed. Two cases had taken the stereotactic brain biopsy and the histopathologic diagnosis was angiitis. Five cases were treated with methylprednisolone and cyclophosphamide was added on in 1 case. Good prognosis was found in all cases. Infratentorial PACNS mostly attacks middle-aged males. The lesions tend to locate in unilateral pons, brachium pontis, cerebellum and midbrain. Hemorrhage or microhemorrhage in lesions is often found by SWI and no hyperperfusion is shown by ASL, which would be useful to distinguish PACNS from malignant tumors. Given the limitations of brain biopsy in clinical practice, clinical and imaging features would be helpful to diagnose PACNS.
[Mh] Termos MeSH primário: Encéfalo/diagnóstico por imagem
Artérias Cerebrais/diagnóstico por imagem
Artérias Cerebrais/patologia
Vasculite do Sistema Nervoso Central/diagnóstico por imagem
Vasculite do Sistema Nervoso Central/patologia
[Mh] Termos MeSH secundário: Ácido Aspártico/análogos & derivados
Biópsia
Líquido Cefalorraquidiano
China
Colina/sangue
Ciclofosfamida/uso terapêutico
Feminino
Cefaleia/etiologia
Seres Humanos
Imagem por Ressonância Magnética
Espectroscopia de Ressonância Magnética
Masculino
Metilprednisolona/uso terapêutico
Meia-Idade
Medula Espinal/diagnóstico por imagem
Resultado do Tratamento
Vasculite do Sistema Nervoso Central/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
30KYC7MIAI (Aspartic Acid); 8N3DW7272P (Cyclophosphamide); 997-55-7 (N-acetylaspartate); N91BDP6H0X (Choline); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170330
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0578-1426.2017.04.009


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[PMID]:28340158
[Au] Autor:de Boysson H; Parienti JJ; Arquizan C; Boulouis G; Gaillard N; Régent A; Néel A; Detante O; Touzé E; Aouba A; Bienvenu B; Guillevin L; Naggara O; Zuber M; Pagnoux C
[Ad] Endereço:Department of Internal Medicine, Caen University Hospital, University of Caen-Basse Normandie.
[Ti] Título:Maintenance therapy is associated with better long-term outcomes in adult patients with primary angiitis of the central nervous system.
[So] Source:Rheumatology (Oxford);56(10):1684-1693, 2017 Oct 01.
[Is] ISSN:1462-0332
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: We aimed to analyse the effect of maintenance therapy after induction on the outcomes of adult patients with primary angiitis of the CNS (PACNS). Methods: We analysed long-term outcomes (relapse, survival and functional status) of patients enrolled in the French multicentre PACNS cohort who achieved remission after induction treatment and with ⩾12 months' follow-up, according to whether or not they received maintenance therapy. Good outcome was defined as relapse-free survival and good functional status (modified Rankin scale ⩽ 2) at last follow-up. Results: Ninety-seven patients [46 (47%) female, median age: 46 (18-78) years at diagnosis] were followed up for a median of 55 (5-198) months. Induction treatment consisted of glucocorticoids in 95 (98%) patients, combined with an immunosuppressant in 80 (83%) patients, mostly CYC. Maintenance therapy was prescribed in 48 (49%) patients, following CYC in 42 of them. Maintenance therapy was started 4 (3-18) months after glucocorticoid initiation. At last follow-up, good outcomes were observed in 32 (67%) patients who had received maintenance therapy vs 10 (20%) who had not (P < 0.0001). Thirty-two (33%) patients experienced relapse [10 (22%) had received maintenance therapy while 22 (45%) had not, P = 0.01]; four subsequently died from relapse. In the multivariate analysis, maintenance therapy was the only independent predictor of good outcome [odds ratio (OR) = 7.8 (95% CI: 3.21, 20.36), P < 0.0001]. Conclusion: The results of this long-term follow-up study suggest that maintenance therapy in adults with PACNS is associated with better functional outcomes and lower relapse rates. Further studies are needed to confirm these findings.
[Mh] Termos MeSH primário: Glucocorticoides/administração & dosagem
Imunossupressores/administração & dosagem
Quimioterapia de Indução/métodos
Quimioterapia de Manutenção/métodos
Vasculite do Sistema Nervoso Central/tratamento farmacológico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Estudos de Coortes
Intervalo Livre de Doença
Feminino
Seguimentos
França
Seres Humanos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Recidiva
Índice de Gravidade de Doença
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Glucocorticoids); 0 (Immunosuppressive Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170325
[St] Status:MEDLINE
[do] DOI:10.1093/rheumatology/kex047



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