CNS small vessel vasculitis: Distinct MRI features and histopathological correlation.

BACKGROUND: Central nervous system (CNS) vasculitis is an uncommon disease, which is a diagnostic and therapeutic challenge for physicians. Large and medium vessel vasculitis is relatively easy to diagnose by angiogram compared to small vessel vasculitis, where angiograms are often normal; imaging features described till date are sensitive but not specific. PURPOSE: Here, we describe distinct magnetic resonance (MR) imaging features of CNS small vessel vasculitis. MATERIALS AND METHODS: Five histologically proven small vessel vasculitis cases were retrospectively reviewed from medical records between January 2008 to July 2012. Angiogram (magnetic resonance angiography in all and digital subtraction angiography in three patients) were normal, ruling out associated large and medium vessel vasculitis. The MR imaging findings were analyzed for T2/fluid-attenuated inversion recovery (FLAIR) hyperintensities and blooming on susceptibility weighted imaging (SWI). RESULTS: Five patients (3 males) with a mean age of 34.2 years (range: 18 to 62 years) were included for analysis. Three patients with lymphocytic vasculitis had 43 discrete T2/FLAIR hyperintense lesions in brain parenchyma. All the brain lesions revealed central areas of SWI blooming in linear and/or lace-like pattern, surrounded by FLAIR hyperintensity. Corresponding T1-weighted contrast-enhanced images revealed subtle linear and lace-like enhancement. Coarse granular pattern of SWI blooming was seen in the patient with tuberculous vasculitis and no parenchymal abnormalities were seen in the patient with hypertrophic pachymeningitis. CONCLUSIONS: The linear SWI blooming along the course of small cerebral vessels and lace-like enhancement pattern in spin echo post-contrast T1-weighted sequences are suggestive MR imaging features for lymphocytic CNS small vessel vasculitis.

Imprecise eponyms in stroke medicine - A growing need for uniform terminologies/definitions across the globe.

BACKGROUND: Remarkable advancements in the understanding of etiological risk factors and pathophysiology of cerebrovascular diseases have led to the refining of definitions and terminologies in stroke medicine periodically. We aim to analyze the utility and meaning of different eponyms in the stroke medicine literature during the last 20 years. MATERIALS AND METHODS: A systematic search was performed in Google Scholar for the words "stroke," "TIA," "cerebrovascular accident (CVA)," "cerebrovascular insult," "cerebrovascular event," "cerebral ischemia," and "cerebrovascular disease." Each of the words were searched yearwise from 1996 to 2015, and the numbers of articles using these words were collected and analyzed. RESULTS: ": Stroke" has been the most common terminology used in literature, which showed a progressive increase in its usage until 2010, after which its use drastically reduced. "Cerebrovascular events" and "cerebral ischemia" are the second most commonly used terminologies with variable definitions; there was a steep increase in the use of these words until 2012. CONCLUSIONS: The most imprecise term that continues to be used is "CVA". The precisely defined entity like "cerebrovascular disease," which is a group of diseases, continues to be used inappropriately. All the terms are not defined uniformly across the globe, whereas most continue to use the World Health Organisation definition of stroke, defined in the 1970s. It is essential to condemn the use of imprecise terminologies and promote the use of recently defined precise terms "stroke" and "transient ischemic attack (TIA)". Unless the same terms with precise definitions are used in clinical practice or literature, the progress of stroke medicine will continue to be hampered.