Neuroradiologic findings in polyarteritis nodosa.

PURPOSE: To demonstrate the neuroradiologic findings in patients with polyarteritis nodosa. METHODS: A review of hospital records for a 10-year period revealed 50 patients with a discharge diagnosis of polyarteritis nodosa. Thirteen patients had undergone neuroimaging, and abnormal findings were found in 5 cases; these were the subjects of this study. RESULTS: All 5 patients had abnormal findings on CT scans, 3 had abnormal findings on MR images, and 1 had an abnormal finding on a cerebral angiogram. All patients had cerebral cortical or subcortical infarctions, and 1 also had small infarctions within the brain stem and cerebellum. One patient had cerebral angiographic findings of arteritis. The diagnosis of arteritis was considered probable or possible in 3 other patients. Three patients had echocardiographic evidence of concentric hypertrophy and a hypocontractile left ventricle resulting from polyarteritis nodosa-related hypertension. Cardiogenic embolism was considered the likely cause in 1 patient. CONCLUSION: Small peripheral cerebral infarctions, consistent with an arteritis involving medium-sized and small arteries, were the most common finding. However, cardiogenic embolism should also be considered as a possible cause of cerebral infarction in patients with polyarteritis nodosa who have left ventricular dysfunction.

Duke Scholars

Author James Michael Provenzale Radiology, Neuroradiology

Author Nancy Bates Allen Medicine, Rheumatology and Immunology