Cerebral Vasculitis- MR Angiogram

We had a young male patient showing characteristically on MRI brain multiple bilateral gray/white matter infarcts were noted in a young patient. They were all supratentorial in distribution, a point further supported by literature. (Radiology 1992;192 :65-72. ). Further evaluation was done with MR angiography There were multiple areas of alternate narrowing and dilatations giving rise to “string of beads” appearance involving the right MCA and ACA.
These are characteristic of vasculitis.

Differential diagnosis considered was -
-Infectious- Bacterial/viral
Tuberculosis is a common cause.
-Non infectious-collagen vascular disorders, neurosarcoidosis, drug abuse, PAN. Other like-GCA, Takasayu, Wegeners.
-Also such appearance can be mimicked by-neoplasm/SAH

- PRIMARY ANGITIS OF THE CNS (PACNS) can be a diagnosis of exclusion

Case submitted by Dr Sumer Sethi, MD, Dr Jaya Shankar, MD

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