PT  - JOURNAL ARTICLE
AU  - Girish Bathla
AU  - Lama Abdel-Wahed
AU  - Amit Agarwal
AU  - Tracey A. Cho
AU  - Sarika Gupta
AU  - Karra A. Jones
AU  - Sarv Priya
AU  - Neetu Soni
AU  - Bruce A. Wasserman
TI  - Vascular Involvement in Neurosarcoidosis
AID  - 10.1212/NXI.0000000000001063
DP  - 2021 Nov 01
TA  - Neurology - Neuroimmunology Neuroinflammation
PG  - e1063
VI  - 8
IP  - 6
4099  - http://nn.neurology.org/content/8/6/e1063.short
4100  - http://nn.neurology.org/content/8/6/e1063.full
SO  - Neurol Neuroimmunol Neuroinflamm2021 Nov 01; 8
AB  - Background and Objectives Cerebrovascular manifestations in neurosarcoidosis (NS) were previously considered rare but are being increasingly recognized. We report our preliminary experience in patients with NS who underwent high-resolution vessel wall imaging (VWI).Methods A total of 13 consecutive patients with NS underwent VWI. Images were analyzed by 2 neuroradiologists in consensus. The assessment included segment-wise evaluation of larger- and medium-sized vessels (internal carotid artery, M1-M3 middle cerebral artery; A1-A3 anterior cerebral artery; V4 segments of vertebral arteries; basilar artery; and P1-P3 posterior cerebral artery), lenticulostriate perforator vessels, and medullary and deep cerebral veins. Cortical veins were not assessed due to flow-related artifacts. Brain biopsy findings were available in 6 cases and were also reviewed.Results Mean patient age was 54.9 years (33–71 years) with an M:F of 8:5. Mean duration between initial diagnosis and VWI study was 18 months. Overall, 9/13 (69%) patients had vascular abnormalities. Circumferential large vessel enhancement was seen in 3/13 (23%) patients, whereas perforator vessel involvement was seen in 6/13 (46%) patients. Medullary and deep vein involvement was also seen in 6/13 patients. In addition, 7/13 (54%) patients had microhemorrhages in susceptibility-weighted imaging, and 4/13 (31%) had chronic infarcts. On biopsy, 5/6 cases showed perivascular granulomas with vessel wall involvement in all 5 cases.Discussion Our preliminary findings suggest that involvement of intracranial vascular structures may be a common finding in patients with NS and should be routinely looked for. These findings appear concordant with previously reported autopsy literature and need to be validated on a larger scale.AZA=azathioprine; CAD=coronary artery disease; CNE=cranial nerve enhancement; DM-2=type 2 diabetes; DWI=diffusion-weighted imaging; EE=ependymal enhancement; FLAIR=fluid-attenuated inversion recovery; HC=hydrocephalus; HL=hyperlipidemia; HT=hypertension; INX=infliximab; LME=leptomeningeal enhancement; LSP=lenticulostriate perforator; MMF=mycophenolate mofetil; MinIP=minimum intensity projection; MTX=methotrexate; NEWM=nonenhancing white matter; NS=neurosarcoidosis; NT=not tested; PGE=parenchymal granulomatous enhancement; PME=pachymeningeal enhancement; PVE=perivascular enhancement; RTX=rituximab; SPACE=sampling perfection with application-optimized contrasts using different flip angle evolution; SWI=susceptibility-weighted imaging; VWI=vessel wall imaging; FSR=Foundation of Sarcoidosis Research