When is brain biopsy useful/warranted as part of the diagnostic work-up in patients with suspected primary CNS angiitis?
Answer from: at Community Practice
I have never dx or seen a patient with primary angiitis of CNS, first I would make sure the suspected dx and findings are confined to the CNS and are not associated with a systemic inflammatory disease; if not confined to the CNS, other areas of the body may be less invasive and more accessible ...
Rarely. As mentioned above, true PACNS is very very rare (though I have seen 1 biopsy-confirmed case); a diagnosis of PACNS requires biopsy. However, other non-inflammatory mimics are much more common, namely RCVS. This can be readily distinguished based on clinical grounds and thus spare a brain bi...
When suspecting PACNS the workup should include LP, vessel wall imaging, and retina exam; if all negative consider other things on the differential as well. We should have a low threshold for biopsy.
Progressive white matter disease, progressive dementia, recurrent cryptogenic strokes after e...