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Cryptogenic stroke as initial manifestation of CNS vasculitis: demonstration of vessel wall enhancement on 1.5T MRI using volumetric T1 TSE sequence
  1. Khaled Badran1,
  2. Avinash Kumar Kanodia2,
  3. Mohamed Abdelsadg1,
  4. James Galea1
  1. 1Department of Neurosurgery, Ninewells Hospital, Dundee, UK
  2. 2Department of Radiology, Ninewells Hospital, Dundee, UK
  1. Correspondence to Dr Avinash Kumar Kanodia, avinash.kanodia{at}

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Central nervous system (CNS) vasculitis secondary to lupus anticoagulant is a rare but potentially lethal condition.1 We present a case report of a patient who presented with stroke and subsequently developed basilar artery ectasia and luminal abnormalities secondary to CNS vasculitis associated with antiphospholipid syndrome. We wish to highlight the role of relatively new MRI volumetric single slab 3D fast spin echo (FSE) sequence with slab-elective, variable excitation pulse, resulting in T1-weighting that does not cause vessel lumen enhancement although can show enhancement in inflamed vessel wall and other tissues.

A 56-year-old man initially presented with right-sided transient ischaemic attacks. He had a history of headaches and was thought to have aseptic meningitis in the past. Initial CT and MRI performed were normal. Within a few weeks, he re-presented with right hemiparesis and homonymous hemianopia. Imaging from his second admission demonstrated an acute infarct within the left posterior cerebral artery (PCA) territory (figure 1). MR angiogram showed a normal basilar top and occluded left PCA (figure 2). He improved clinically over the next few days although he was noted to have significant cognitive impairment which precluded his return to work. Ancillary investigations for stroke were in keeping with a diagnosis of antiphospholipid syndrome (high positive β-2 microglobulin antibodies) and a bubble echocardiogram also demonstrated a patent foramen ovale. He was therefore given anticoagulants. IgG and IgM anticardiolipin antibodies were normal. Antinuclear antibodies, antineutrophil cytoplasmic antibody and Extractable Nuclear Antigen (ENA) screen were negative. IgM anti-β 2 …

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