CNS Vasculitis: an Approach to Differential Diagnosis and Management

• Published in: Current rheumatology reports Vol. 20; no. 7; p. 37
• Main Authors: Byram, Kevin, Hajj-Ali, Rula A., Calabrese, Leonard
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2018
• Subjects: Cyclophosphamide - therapeutic use; Diagnosis, Differential; Glucocorticoids - therapeutic use; Humans; Immunosuppressive Agents - therapeutic use; Medicine; Medicine & Public Health; Rheumatology; Section Editor; Topical Collection on Vasculitis; Vasculitis (L Espinoza; Vasculitis, Central Nervous System - diagnosis; Vasculitis, Central Nervous System - drug therapy; Primary angiitis of the central nervous system; Primary central nervous system vasculitis; Primary CNS vasculitis; CNS vasculitis
• ISSN: 1523-3774; 1534-6307
• DOI: 10.1007/s11926-018-0747-z

Purpose of Review The goal of this review is to provide an up-to-date approach to diagnosis and management of patients with central nervous system (CNS) vasculitis. Recent Findings Challenges in diagnosis of CNS vasculitis still exist due to the broad differential diagnosis and generally nonspecific initial clinical manifestations. Differentiation between primary angiitis of the CNS (PACNS) and secondary causes is important in guiding management. Recent longitudinal cohort studies have improved our understanding of PACNS. Advances in neuroimaging and molecular testing have enhanced diagnostic decision-making. Therapy remains largely empiric, guided by observational data. Despite the limited use of targeted therapies, glucocorticoids and cyclophosphamide remain the mainstays of therapy in PACNS. Summary Securing a diagnosis through a careful, team-based approach with emphasis on ruling out possible mimics is paramount in the management of patients with CNS vasculitis.