Clinical Management of Infectious Cerebral Vasculitides

Expert Rev Neurother. 2016;16(2):205-21. doi: 10.1586/14737175.2015.1134321. Epub 2016 Jan 19.

Abstract

A wide range of infections (virus, bacteria, parasite and fungi) may cause cerebral vasculitides. Headache, seizures, encephalopathy and stroke are common forms of presentation. Infection and inflammation of intracranial vessels may cause pathological vascular remodelling, vascular occlusion and ischemia. Vasculitis in chronic meningitis may cause ischemic infarctions, and is associated with poor outcome. Appropriate neuroimaging (CT-angiography, MR-angiography, conventional 4-vessel angiography) and laboratory testing (specific antibodies in blood and CSF, CSF culture and microscopy) and even brain biopsy are needed to quickly establish the aetiology. Enhancement of contrast, wall thickening and lumen narrowing are radiological signs pointing to an infectious vasculitis origin. Although corticosteroids and prophylactic antiplatelet therapy have been used in infectious cerebral vasculitis, there are no randomized clinical trials that have evaluated their efficacy and safety. Stable mycotic aneurysms can be treated with specific antimicrobial therapy. Endovascular therapy and intracranial surgery are reserved for ruptured aneurysms or enlarging unruptured aneurysms.

Keywords: Cerebral vasculitis; Lyme disease; VZV vasculopathy; infectious disease; infectious vasculitides; mycotic aneurysm; stroke; syphilis.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Aneurysm, Infected / complications
  • Aneurysm, Infected / diagnosis
  • Aneurysm, Infected / therapy*
  • Anti-Infective Agents / therapeutic use*
  • Central Nervous System Fungal Infections / complications
  • Central Nervous System Fungal Infections / diagnosis
  • Central Nervous System Fungal Infections / therapy
  • Cerebral Angiography
  • Disease Management
  • Encephalitis, Varicella Zoster / complications
  • Encephalitis, Varicella Zoster / diagnosis
  • Encephalitis, Varicella Zoster / therapy
  • Endovascular Procedures*
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / diagnosis
  • Intracranial Aneurysm / therapy*
  • Lyme Neuroborreliosis / complications
  • Lyme Neuroborreliosis / diagnosis
  • Lyme Neuroborreliosis / therapy
  • Magnetic Resonance Angiography
  • Meningitis, Bacterial / complications
  • Meningitis, Bacterial / diagnosis
  • Meningitis, Bacterial / therapy
  • Neurocysticercosis / complications
  • Neurocysticercosis / diagnosis
  • Neurocysticercosis / therapy
  • Neurosyphilis / complications
  • Neurosyphilis / diagnosis
  • Neurosyphilis / therapy
  • Platelet Aggregation Inhibitors / therapeutic use
  • Thrombolytic Therapy
  • Tomography, X-Ray Computed
  • Tuberculosis, Meningeal / complications
  • Tuberculosis, Meningeal / diagnosis
  • Tuberculosis, Meningeal / therapy
  • Vasculitis, Central Nervous System / complications
  • Vasculitis, Central Nervous System / diagnosis
  • Vasculitis, Central Nervous System / therapy*

Substances

  • Adrenal Cortex Hormones
  • Anti-Infective Agents
  • Platelet Aggregation Inhibitors