Vasculitis and the nervous system:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
1997
|
| Series: | Neurologic clinics
15,4 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XIII S., S. 737 - 1014 Ill. |
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| 245 | 1 | 0 | |a Vasculitis and the nervous system |c David S. Younger guest ed. |
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Record in the Search Index
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VAPCl.'l IT1S AND THF NERVOUS RYRTPM
CONTENTS
Preface xiii
David S. Younger
Vasculitis and the Nervous System:
Historical Perspective and Overview 737
David S. Younger and Robin M. Kass
This article is an introduction to the historical background, clinical
and laboratory diagnosis, pathogenesis, and treatment of vasculitis
involving the peripheral and central nervous system. It also pro¬
vides a background for the articles that follow.
Diagnostic Approach to Central and Peripheral
Nervous System Vasculitis 759
Stephen E. Nadeau
The diagnosis of vasculitis is first and foremost a clinical one. Cor¬
rect diagnosis requires a high index of suspicion coupled with
knowledge of the manifestations of other disorders that may mas¬
querade as vasculitis. Treatment of vasculitis requires prolonged
use of drugs with the potential for serious side effects. Whereas the
prompt initiation of definitive treatment is a very high priority,
there is also substantial risk of inappropriately treating self limited
and more benign disorders mimicking vasculitis. This has been a
particular problem with primary angiitis of the central nervous
system. Laboratory studies, particularly tissue biopsy, provide a
crucial adjunct to clinical diagnosis.
Radiographic Features of Central Nervous System Vasculitis 779
Peter J. Wynne, David S. Younger, Alexander Khandji,
and A. John Silver
Central nervous system (CNS) vasculitis refers to primary and sec¬
ondary disorders of the CNS vasculature. Most authorities agree
NEUROLOGIC CLINICS
that CNS vasculitis is a potentially serious disorder; therefore,
prompt diagnosis and initiation of therapy are high priorities in
treatment. Remarkable progress has been made in the diagnosis,
evaluation, and treatment of this disorder. This article examines
many aspects of the radiographic evaluation of CNS vasculitis.
Classification and Histopathologic Spectrum of Central
Nervous System Vasculitis 805
J.T. Lie
There are many different and diverse causes of central nervous
system (CNS) vasculitis, and many nonvasculitic disorders that of¬
ten mimic CNS vasculitis. CNS vasculitis is usually suspected clin¬
ically with compatible or suggestive angiographic findings, but a
definitive diagnosis is not possible without biopsy confirmation,
especially with CNS vasculitis mimickers. Primary CNS vasculitis,
although relatively uncommon, is most important because of its
overall unfavorable prognosis. Secondary CNS vasculitis occurs in
association with a long list of systemic vasculitic and nonvasculitic
disorders with variable brain biopsy findings. Because of the focal
and segmental distribution of CNS vasculitis, a positive biopsy is
diagnostic for the disease demonstrated, but a single isolated neg¬
ative biopsy does not necessarily exclude primary or secondary
CNS vasculitis.
Granulomatous Angiitis of the Nervous System 821
David S. Younger, Leonard H. Calabrese, and Arthur P. Hays
Granulomatous angiitis of the nervous system (GANS) refers to
distinctive clinicopathologic disorders with the essential feature of
granulomatous inflammation of cerebral and spinal vessels, accom¬
panied by multinucleate giant cells and epithelioid cells. This ar¬
ticle reviews and examines the clinical, laboratory, and neuropath
ologic findings of patients with granulomatous angiitis.
Necrotizing Peripheral Nerve Vasculitis 835
Gerard Said
Necrotizing vasculitis of the type in polyarteritis nodosa is a treat¬
able cause of neuropathy. The diagnosis must be confirmed his
tologically by demonstration of characteristic arterial lesions in
nerve and muscle biopsy specimens. Ischemic neuropathy which
results from occlusion of nerve arteries in polyarteritis nodosa also
occurs as a consequence of inflammatory arterial lesions in other
connective tissue disorders, in some infectious neuropathies and in
patients with malignant lymphomas. Patients with vasculitic neu¬
ropathy may also present with isolated peripheral neuropathy.
Paraneoplastic Vasculitis of the Peripheral Nervous System 849
Shin J. Oh
Paraneoplastic vasculitic neuropathy (PVN) is a rare paraneoplas¬
tic syndrome characterized by non systemic subacute vasculitic
neuropathy. The two cancers most commonly associated with PVN
are small cell lung cancer (SCLC) and lymphomas. Neuropathy
varies from mononeurotherapy multiplex to symmetrical polyneu
ropathy. Two helpful laboratory abnormalities are a high eryth
rocyte sedimentation rate (ESR) and high cerebro spinal fluid (CSF)
protein content. Axonal neuropathy is the characteristic finding in
electrophysiological studies. Nerve biopsy is crucial to document
microvasculitis. Recognition of this entity is important because of
its potential treatability. Unlike other paraneoplastic syndromes,
anti cancer chemotherapy and immunotherapy for vasculitis are
both effective in this disorder.
Polyarteritis Nodosa, Microscopic Polyangiitis,
and Churg Strauss Syndrome:
Clinical Aspects, Neurologic Manifestations, and Treatment 865
Loi'c Guillevin, Francois Lhote, and Romain Gherardi
Polyarteritis nodosa (PAN), microscopic polyangiitis (MPA), and
Churg Strauss syndrome (CSS) all have neurologic symptoms and
share characteristics and outcomes. Clinical aspects, neurologic
manifestations, and treatment of these three diseases are examined
in this article.
Wegener's Granulomatosis and ANCA Syndromes 887
Israeli A. Jaffe
The nervous system is involved in approximately 25% of patients
with classical Wegener's granulomatosis. The spectrum of this dis¬
ease has been broadened with the discovery of the anti neutrophil
cytoplasmic antibodies, which are found in diseases sharing many
clinical features. The ANCA testing may indicate a common mode
of pathogenesis. The definitive diagnostic marker is histological,
and that forms the best guide to specific therapy.
Giant Cell (Temporal) Arteritis 893
Richard J. Caselli and Gene G. Hunder
Headache is the most frequent symptom for which a patient with
giant cell arteritis (GCA) presents to a neurologist. Amaurosis fu
gax and ischemic optic neuropathy are well recognized complica¬
tions. Less commonly recognized neurologic complications include
transient ischemic attacks, cerebral infarctions, acute confusional
states, multi infarct dementia, ischemic cervical myelopathy, and
ischemic mononeuropathies. Because patients with GCA generally
respond well to corticosteroid therapy, prompt diagnosis can min¬
imize neurologic damage.
Vasculitis Owing To Infection 903
P.K. Coyle, Oded Gerber, and Clemente Roque
Infections are a recognized cause of secondary vasculitis. A variety
of pathogens have a propensity to involve blood vessels. Vasculitis,
non vasculitic vasculopathy, and mycotic aneurysms lead to in¬
farction and hemorrhage of nervous system tissue. Treatment of
infection related vasculitis should include appropriate antimicro¬
bial therapy directed against the offending pathogen, and
appropriate management of cerebrovascular complications.
Retroviral Associated Vasculitis of the Nervous System 927
Thomas H. Brannagan III
Vasculitis may involve the central and peripheral nervous system
in HIV infected patients. Central nervous system vasculitis is rare
with HIV infection and most are owing to opportunistic infections
including varicella, CMV, fungal, tuberculosis, and syphilis. Vas¬
culitis of the peripheral nerve may cause mononeuritis multiplex
or polyneuropathy, sometimes as the first symptom of HIV or after
AIDS has developed. Symptoms may be limited to the peripheral
nerve. The etiology may be infection of endothelial cells, hepatitis
B or HIV induced immune complexes, or dysregulation of cyto
kines and adhesion molecules. Treatment with steroids alone is
often effective; IVIg and cytotoxic agents have also been used. It is
uncertain whether vasculitis of the nervous system is ever due to
other retroviruses (HIV 2, HTLV 1, and HTLV 2).
Vasculitis Owing To Substance Abuse 945
John CM Brust
The term drug dependence refers to psychic dependence (addic¬
tion), physical dependence, or both, in someone who administers
a drug periodically or continuously. Recreational drug abusers are
at risk for occlusive and hemorrhagic stroke of diverse cause. Al¬
though sometimes over diagnosed, cerebral vasculitis has been his¬
torically verified in users of legal and illegal drugs.
Autoimmune Diabetic Neuropathy 959
David A. Krendel, Alan Zacharias, and David S. Younger
Recent work has shown that inflammatory vasculopathy is com¬
monly seen in biopsies of diabetic patients with neuropathy. Most
of these patients have had syndromes consistent with proximal
diabetic neuropathy or amyotrophy. This suggests that inflam¬
matory vasculopathy is important in the pathogenesis of these dis¬
orders. Immunosuppressive therapy may benefit many of these
patients.
Therapy of Systemic Vasculitis 973
Leonard H. Calabrese
The systemic vasculitides represent a highly heterogeneous and
complex set of disorders primarily mediated via immunologic
mechanisms. Standard therapy of these diseases includes the use
of glucocorticoids without the use of additional cytotoxic agents.
Recent long term follow up investigations of patients treated with
combined therapy has revealed an alarming incidence of treat¬
ment related toxicity. Currently recommended therapeutic regi¬
mens are designed to minimize such toxicity while maintaining
disease control. New therapeutic agents with greater disease spec¬
ificity and lower toxicity are now being examined.
Cumulative Index 1997 993
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| spelling | Vasculitis and the nervous system David S. Younger guest ed. Philadelphia [u.a.] Saunders 1997 XIII S., S. 737 - 1014 Ill. txt rdacontent n rdamedia nc rdacarrier Neurologic clinics 15,4 Centraal zenuwstelsel gtt Perifere zenuwstelsel gtt Vaatontstekingen gtt Vascularite - physiopathologie Vasculitis Vasculitis physiopathology Vaskulitis (DE-588)4125620-7 gnd rswk-swf Nervensystem (DE-588)4041643-4 gnd rswk-swf Krankheit (DE-588)4032844-2 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Vaskulitis (DE-588)4125620-7 s Nervensystem (DE-588)4041643-4 s Krankheit (DE-588)4032844-2 s DE-604 Younger, David S. Sonstige oth Neurologic clinics 15,4 (DE-604)BV000003008 15,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007898733&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Vasculitis and the nervous system Neurologic clinics Centraal zenuwstelsel gtt Perifere zenuwstelsel gtt Vaatontstekingen gtt Vascularite - physiopathologie Vasculitis Vasculitis physiopathology Vaskulitis (DE-588)4125620-7 gnd Nervensystem (DE-588)4041643-4 gnd Krankheit (DE-588)4032844-2 gnd |
| subject_GND | (DE-588)4125620-7 (DE-588)4041643-4 (DE-588)4032844-2 (DE-588)4143413-4 |
| title | Vasculitis and the nervous system |
| title_auth | Vasculitis and the nervous system |
| title_exact_search | Vasculitis and the nervous system |
| title_full | Vasculitis and the nervous system David S. Younger guest ed. |
| title_fullStr | Vasculitis and the nervous system David S. Younger guest ed. |
| title_full_unstemmed | Vasculitis and the nervous system David S. Younger guest ed. |
| title_short | Vasculitis and the nervous system |
| title_sort | vasculitis and the nervous system |
| topic | Centraal zenuwstelsel gtt Perifere zenuwstelsel gtt Vaatontstekingen gtt Vascularite - physiopathologie Vasculitis Vasculitis physiopathology Vaskulitis (DE-588)4125620-7 gnd Nervensystem (DE-588)4041643-4 gnd Krankheit (DE-588)4032844-2 gnd |
| topic_facet | Centraal zenuwstelsel Perifere zenuwstelsel Vaatontstekingen Vascularite - physiopathologie Vasculitis Vasculitis physiopathology Vaskulitis Nervensystem Krankheit Aufsatzsammlung |
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