Vascular Involvement in Neurosarcoidosis: Early Experiences From Intracranial Vessel Wall Imaging

Girish Bathla; Lama Abdel-Wahed; Amit Agarwal; Tracey A Cho; Sarika Gupta; Karra A Jones; Sarv Priya; Neetu Soni; Bruce A Wasserman

doi:10.1212/NXI.0000000000001063

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Vascular Involvement in Neurosarcoidosis: Early Experiences From Intracranial Vessel Wall Imaging

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Vascular Involvement in Neurosarcoidosis: Early Experiences From Intracranial Vessel Wall Imaging

Girish Bathla, Lama Abdel-Wahed, Amit Agarwal, Tracey A Cho, Sarika Gupta, Karra A Jones, Sarv Priya, Neetu Soni and Bruce A Wasserman

Neurology® neuroimmunology & neuroinflammation, Vol.8(6), e1063

11/01/2021

DOI: 10.1212/NXI.0000000000001063

PMCID: PMC8340434

PMID: 34349028

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Abstract

BACKGROUND AND OBJECTIVESCerebrovascular manifestations in neurosarcoidosis (NS) were previously considered rare but are being increasingly recognized. We report our preliminary experience in patients with NS who underwent high-resolution vessel wall imaging (VWI). METHODSA total of 13 consecutive patients with NS underwent VWI. Images were analyzed by 2 neuroradiologists in consensus. The assessment included segment-wise evaluation of larger- and medium-sized vessels (internal carotid artery, M1-M3 middle cerebral artery; A1-A3 anterior cerebral artery; V4 segments of vertebral arteries; basilar artery; and P1-P3 posterior cerebral artery), lenticulostriate perforator vessels, and medullary and deep cerebral veins. Cortical veins were not assessed due to flow-related artifacts. Brain biopsy findings were available in 6 cases and were also reviewed. RESULTSMean patient age was 54.9 years (33-71 years) with an M:F of 8:5. Mean duration between initial diagnosis and VWI study was 18 months. Overall, 9/13 (69%) patients had vascular abnormalities. Circumferential large vessel enhancement was seen in 3/13 (23%) patients, whereas perforator vessel involvement was seen in 6/13 (46%) patients. Medullary and deep vein involvement was also seen in 6/13 patients. In addition, 7/13 (54%) patients had microhemorrhages in susceptibility-weighted imaging, and 4/13 (31%) had chronic infarcts. On biopsy, 5/6 cases showed perivascular granulomas with vessel wall involvement in all 5 cases. DISCUSSIONOur preliminary findings suggest that involvement of intracranial vascular structures may be a common finding in patients with NS and should be routinely looked for. These findings appear concordant with previously reported autopsy literature and need to be validated on a larger scale.

Details

Title: Subtitle: Vascular Involvement in Neurosarcoidosis: Early Experiences From Intracranial Vessel Wall Imaging
Creators: Girish Bathla - University of Iowa Hospitals and Clinics
Lama Abdel-Wahed - University of Iowa Hospitals and Clinics
Amit Agarwal - Mayo Clinic in Florida
Tracey A Cho - University of Iowa Hospitals and Clinics
Sarika Gupta - University of Iowa Hospitals and Clinics
Karra A Jones - University of Iowa Hospitals and Clinics
Sarv Priya - University of Iowa Hospitals and Clinics
Neetu Soni - University of Iowa Hospitals and Clinics
Bruce A Wasserman - Johns Hopkins University
Resource Type: Journal article
Publication Details: Neurology® neuroimmunology & neuroinflammation, Vol.8(6), e1063
DOI: 10.1212/NXI.0000000000001063
PMID: 34349028
PMCID: PMC8340434
NLM abbreviation: Neurol Neuroimmunol Neuroinflamm
ISSN: 2332-7812
Language: English
Date published: 11/01/2021
Academic Unit: Neurology; Radiology; Pathology; Iowa Neuroscience Institute
Record Identifier: 9984186516002771

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