The Clinical Analysis Of 21 Cases With Primary Angiitis Of The Central Nervous System

Objective: By collecting,summarizing and analyzing the clinical data of patients with primary angiitis of the central nervous system(PACNS),and reviewing relevant literature,we try to explore possible new understandings of the clinical features,diagnosis and treatment of PACNS.Methods:The clinical data were retrospectively analyzed from the 21 patients with primary angiitis of the central nervous system(PACNS)who were hospitalized in the Department of Neurology of the Second Hospital of Hebei Medical University from October 2015 to September 2020.All data were recorded such as general information,clinical symptoms,auxiliary examinations and treatments.All examination results were interpreted and analyzed by two experienced neurologists and neuroradiologists.Through the summary and comparison of their clinical features,auxiliary examinations and treatments,we could explore the possible new understanding of PACNS.Results: 1.The PACNS is prone to attack female,and morbidity is higher in young people.Autumn is the peak season.It progress slowly,and the average time from onset to admission is over 1 month.Surgery and upper respiratory tract infection might be the triggers for the onset of PACNS.Headache and cognitive dysfunction are common prodromal symptoms.The clinical manifestations are diverse and have no obvious specificity.And PACNS did not have the obvious family genetic tendency.The result of cerebrospinal fluid examination clue that patients would have a slight increase in white blood cell count and protein in CSF.Patients with PACNS might have abnormalities in the EEG.Patients in mild strokes with abnormal EEG should be careful about the possibility of PACNS.2.HR-MRI has become an indispensable part of the diagnosis of PACNS.The large and medium cerebrovasculars are the majority of regions involved in PACNS.What’s more,the anterior circulation is more vulnerable than the posterior circulation.The characteristics of PACNS are the wall is uniform,and the ring is thickened with strengthening.3.The current treatments in clinical include following items: glucocorticoid pulse therapy combined(not combined)immunosuppressive therapy or immunoglobulin treatments in acute phase,hormone therapy combined(not combined)immunosuppressive therapy in remission phase.However,the emerging therapy(glucocorticoid pulse therapy combined with intravenous immunoglobulin)is equally effective as traditional remedy.Most PACNS patients have controllable conditions and good prognoses.Conclusions:1.Meeting patients with stroke don’t have obvious vascular risk factors,doctors should concern about the possibility of PACNS when the patient has premonitory symptoms(headache,cognitive disorder and so on),insidious and long course.2.There may be abnormalities in the EEG of some PACNS patients.For patients with mild strokes with abnormal EEG,doctors should be careful about the possibility of PACNS.3.When clinically encountering patients with no obvious risk factors and negative serum immunological test,HR-MRI examination should be performed in time to determine whether patients have PACNS.4.The emerging therapy(glucocorticoid pulse therapy combined with intravenous immunoglobulin)is equally effective as traditional remedy.