Infectious Causes of Multifocal Circle of Willis Stenosis
HIDEInteractive Transcript
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I wanted to discuss a couple of other things
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that cause diffuse multifocal narrowings
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in the circle of Willis,
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and one of them is varicella zoster.
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It's seen in patients with decreased cell immunity,
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so HIV organ transplant are very old,
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like 90 year olds.
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It's due to reactivation of the varicella zoster virus
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due to a decrease in cell-mediated immunity.
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Here at these are images of a 30-year-old female
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with HIV, with acute left over extremity
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weakness and facial numbness,
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and she has a border zone infarct between
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ACAs and MCAs,
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and you can see on her coronal MIP image
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that there are multifocal vascular stenosis
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in the MCAs bilaterally,
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and the bilateral ACAs.
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Another cause of multifocal vascular narrowings
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is tuberculosis meningitis.
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You tend to see it in endemic areas,
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especially in kids,
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and what they have is basilar meningitis.
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As you can see in this case,
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this extensive thickening and enhancement
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of the meninges,
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along the basilar cisterns and extending
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into the Sylvian fissures, and you can get
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inflammation in the vessels and cause narrowing
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of the bilateral MCAs and ACAs
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and get multiple infarcts.
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You can see the patient has multiple
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MCA and ACA infarcts bilaterally.
Pamela W Schaefer, MD, FACR
Professor of Radiology, Vice Chair of Education
Massachusetts General Hospital
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