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CNS vasculitis: Spectrum and differential diagnosis

CNS vasculitis: Spectrum and differential diagnosis
Primary CNS vasculitis
  • Evidence of vasculitis exclusively on angiography: Children, progressive angiography-positive childhood PACNS and nonprogressive angiography-positive childhood PACNS subtypes; adults, PACNS (51% in Mayo clinic cohort)
  • Evidence of vasculitis exclusively on brain biopsy: Children, small-vessel childhood PACNS; adults, PACNS (25% in Mayo clinic cohort)
  • Evidence of vasculitis on angiography and brain biopsy: Children, single cases of childhood PACNS; adults, PACNS (24% in Mayo clinic cohort)
Childhood secondary CNS vasculitis
  • Active infections or postinfectious states: Viral (VZV, HIV, EBV, CMV); bacterial (Mycobacterium tuberculosis, Mycoplasma pneumonia, Streptococcus pneumoniae); fungal (Aspergillus spp, Candida albicans, Actinomyces spp)
  • Systemic rheumatic diseases: SLE, systemic vasculitis, scleroderma, dermatomyositis, plus others
  • Systemic inflammatory diseases: Inflammatory bowel disease, hemophagocytic lymphohistiocytosis, Kawasaki syndrome
  • Other systemic diseases or exposures: Graft-versus-host disease, radiation, malignancies
Adult secondary CNS vasculitis
  • Active infections or postinfectious states: Viral (VZV, HIV, CMV, HBV, HCV, HSV); bacterial (Borrelia burgdorferi [Lyme disease], Treponema pallidum [syphilis], M. tuberculosis, Salmonella typhi, Streptococcus pneumoniae); fungal (Aspergillus, Coccidoides, Mycomycoses, Histoplasma capsulatum, Toxoplasma); protozoa (Toxoplasma, Plasmodium [malaria])
  • Systemic rheumatic diseases: Behçet syndrome, systemic vasculitis (giant cell arteritis, Takayasu arteritis, polyarteritis nodosa and ANCA-associated vasculitis), SLE, sarcoidosis or neurosarcoid, RA, Sjögren syndrome, scleroderma
  • Systemic inflammatory diseases: Inflammatory bowel disease, hemophagocytic lymphohistiocytosis, cryoglobulinemia
  • Other systemic diseases or exposures: Graft-versus-host diseases, radiation, drugs (cocaine, amphetamines, among others), malignancies (Hodgkin and non-Hodgkin lymphoma, among others)
CNS: central nervous system; PACNS: primary angiitis of the CNS; VZV: varicella-zoster virus; HIV: human immunodeficiency virus; EBV: Epstein-Barr virus; CMV: cytomegalovirus; SLE: systemic lupus erythematosus; HBV: hepatitis B virus; HCV: hepatitis C virus; HSV: herpes simplex virus; ANCA: antineutrophil cytoplasmic antibody; RA: rheumatoid arthritis.
Reprinted by permission from Macmillan Publishers Ltd: Nature Reviews Rheumatology. Twilt M, Benseler S. The spectrum of CNS vasculitis in children and adults. Nat Rev Rheumatol 2012; 8:97. Copyright © 2012. www.nature.com/nrrheum.
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