Upcoming Events
Log In
Pricing
Free Trial

Infectious Causes of Multifocal Circle of Willis Stenosis

HIDE
PrevNext

0:00

I wanted to discuss a couple of other things

0:02

that cause diffuse multifocal narrowings

0:06

in the circle of Willis,

0:07

and one of them is varicella zoster.

0:09

It's seen in patients with decreased cell immunity,

0:13

so HIV organ transplant are very old,

0:16

like 90 year olds.

0:17

It's due to reactivation of the varicella zoster virus

0:21

due to a decrease in cell-mediated immunity.

0:24

Here at these are images of a 30-year-old female

0:26

with HIV, with acute left over extremity

0:29

weakness and facial numbness,

0:30

and she has a border zone infarct between

0:33

ACAs and MCAs,

0:34

and you can see on her coronal MIP image

0:38

that there are multifocal vascular stenosis

0:40

in the MCAs bilaterally,

0:42

and the bilateral ACAs.

0:45

Another cause of multifocal vascular narrowings

0:48

is tuberculosis meningitis.

0:50

You tend to see it in endemic areas,

0:53

especially in kids,

0:54

and what they have is basilar meningitis.

0:57

As you can see in this case,

0:58

this extensive thickening and enhancement

1:01

of the meninges,

1:03

along the basilar cisterns and extending

1:05

into the Sylvian fissures, and you can get

1:07

inflammation in the vessels and cause narrowing

1:10

of the bilateral MCAs and ACAs

1:12

and get multiple infarcts.

1:14

You can see the patient has multiple

1:15

MCA and ACA infarcts bilaterally.

Report

Faculty

Pamela W Schaefer, MD, FACR

Professor of Radiology, Vice Chair of Education

Massachusetts General Hospital

Tags

Vascular Imaging

Neuroradiology

Neuro

MRI

Head and Neck

CTA

CT

Brain

© 2024 Medality. All Rights Reserved.

Contact UsTerms of UsePrivacy Policy