[Internal carotid artery vasculitis originated by cervicofacial actinomycosis as a predisponing factor to stroke].
ABSTRACT Actinomycosis is a chronic, suppurative, fibrotic infection produced by a gram-positive anaerobic bacteria of the normal mouth flora, the infection having tendency to fistulate and to extend without respecting tissue layers. Initial diagnosis is usually delayed due to its painless evolution. Three clinical forms are known: cervicofacial, abdominal and thoracic. Occasionally, there is vascular involvement which is mainly associated with venous thrombotic phenomena with low clinical expresion and hematogenous dissemination that can result in a formation of abscess or meningitis in the central nervous system. We report the case of a 28 year old female patient with type I diabetes and microangiopathyc complication with a internal carotid artery stenosis adjacent to mandibular angle actinomicosis. A few months later and after a miscarriage she suffered from ischemic stroke. The anticardiolipin antibody were positive at the time of stroke with post-operative period and over the next two years. To our knowledge (Medline, 1984-2004), it is the first report of internal carotid vasculitis originated by cervicofacial actinomicosis. We discuss the neuroradiological aspects of our case.
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ABSTRACT: To review the current literature of primary and secondary central nervous system vasculitis in children, to evaluate the evolving classification and to suggest an approach to diagnosis. Central nervous system vasculitis in children is a newly recognized inflammatory brain disease, which may develop as a primary condition, or secondary to an underlying systemic disease. Primary angiitis of the central nervous system of childhood (cPACNS) is a reversible cause of severe neurological impairment, including acute ischemic stroke, intractable seizures and cognitive decline. Once clinically suspected, angiography is a key imaging modality. Primary angiitis of the central nervous system of childhood can be divided into large-medium vessel and small-vessel vasculitis, each presenting with distinct clinical and radiological features. Angiogram-negative, small-vessel primary angiitis of the central nervous system of childhood has a broad differential diagnosis that includes both vascular and nonvascular conditions. Recognition of this disease and a thorough diagnostic evaluation is necessary to identify and possibly reverse severe neurological impairment in children. This review summarizes the recent data on diagnosis and differential diagnosis of primary and secondary central nervous system vasculitis in children. Increasing recognition of this condition in children allows for greater understanding of the spectrum of disease presentation and differential diagnosis of this reversible cause of severe neurological impairment in children.Current Opinion in Rheumatology 02/2008; 20(1):47-54. · 5.19 Impact Factor