Clin Rheumatol DOI 10.1007/s10067-014-2831-8
ORIGINAL ARTICLE
Primary and secondary central nervous system vasculitis: clinical manifestations, laboratory findings, neuroimaging, and treatment analysis Olga Vera-Lastra & Jesús Sepúlveda-Delgado & María del Pilar Cruz-Domínguez & Gabriela Medina & Moisés Casarrubias-Ramírez & Luis E. Molina-Carrión & Luis F. Pineda-Galindo & Arturo Olvera-Acevedo & Claudia Hernández-Gonzalez & Luis J. Jara
Received: 7 November 2014 / Accepted: 9 November 2014 # International League of Associations for Rheumatology (ILAR) 2014
Abstract The objectives of this study are to compare the initial clinical, laboratory, and imaging features in primary central nervous system vasculitis (PCNSV) vs secondary central nervous system vasculitis (SCNSV) and follow up after treatment with intravenous cyclophosphamide (IVO. Vera-Lastra (*) : J. Sepúlveda-Delgado : M. P. Cruz-Domínguez : M. Casarrubias-Ramírez : L. F. Pineda-Galindo : A. Olvera-Acevedo Hospital de Especialidades “Dr. Antonio Fraga Mouret,” Centro Médico Nacional La Raza, Internal Medicine Department, Instituto Mexicano del Seguro Social, Seris y Zaachila S/N Col. La Raza, 02990 México City, Mexico e-mail:
[email protected] L. E. Molina-Carrión Neurology Department, Hospital de Especialidades “Dr. Antonio Fraga Mouret,” Centro Médico Nacional LaRaza, Instituto Mexicano del Seguro Social, México City, Mexico G. Medina Clinical Research Unit, Hospital de Especialidades “Dr. Antonio Fraga Mouret,” Centro Médico Nacional LaRaza, Instituto Mexicano del Seguro Social, México City, Mexico C. Hernández-Gonzalez Imagenology Deparment, Hospital de Especialidades “Dr. Antonio Fraga Mouret,” Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México City, Mexico L. J. Jara Direction of Education and Research, Hospital de Especialidades “Dr. Antonio Fraga Mouret,” Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México City, Mexico O. Vera-Lastra : J. Sepúlveda-Delgado : M. P. Cruz-Domínguez : G. Medina : M. Casarrubias-Ramírez : L. E. Molina-Carrión : L. F. Pineda-Galindo : A. Olvera-Acevedo : L. J. Jara Facultad de Medicina, División de Estudios de Posgrado, Universidad Nacional Autónoma de México, México City, Mexico
CYC) plus glucocorticosteroids (GCS): methylprednisolone (MP). Neurological, laboratory, and neuroimaging findings were analyzed in PCNSV and SCNSV patients. Cerebral biopsy (CB) was performed in nine patients. Both groups received at onset MP plus IV-CYC for 6 months, followed by bimonthly IV-CYC plus prednisone (PND) for 12 months. All patients were followed during 36 months. Thirty patients were included (12 PCNSV and 18 SCNSV). Focal and non-focal neurological manifestations were similar in both groups, headache being the most frequent manifestation in both groups. Fatigue, myalgias, arthralgias, neuropathy, low leukocytes and platelets, elevated erythrocyte sedimentation rate, positive antinuclear antibodies (ANA), antidouble-stranded DNA (dsDNA), antineutrophil cytoplasmic antibodies (ANCA), low complement, and rheumatoid factor were more frequent in SCNSV (p
