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Neurological Rehabilitation

CNS Vasculitis – an Unusual Cause of Stroke: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks

    Poster Presenter(s)

  • Supriya Baskaran

    Medical Student
    New York Institute of Technology College of Osteopathic Medicine
    Buchanan, New York

    • Co-Author(s)

  • CV

    Caroline Varlotta, DO

    Physician
    Nuvance Health / Northwell Health
    Norwalk, Connecticut

  • AK

    Avniel Klein, MD, PhD

    Associate Professor
    Mount Sinai Health System
    New York, New York

Disclosure(s):
Supriya Baskaran: No financial relationships to disclose
Caroline Varlotta, DO: No financial relationships to disclose
Avniel Klein, MD, PhD: No financial relationships to disclose
Case Diagnosis: A 44-year-old man with CNS vasculitis

Case Description or Program Description: 44-year-old man with history of hypertension and smoking was admitted following an episode of dizziness, nausea, vomiting, and posterior-headache. Imaging revealed right posterior inferior cerebellar artery (PICA) occlusion and diminutive left PICA flow. Repeat imaging due to increasing restlessness demonstrated enlarging bilateral cerebellar infarcts and hydrocephalus. He underwent suboccipital craniectomy, partial bilateral lobectomy with C1 laminectomy, durotomy to C2, and extra-ventricular drain (EVD) placement and was discharged to Acute Inpatient Rehab. There, he had continued nausea, vomiting and leukocytosis. Lumbar puncture was consistent for bacterial meningitis but was unculturable. Hypercoagulable workup was unremarkable except mildly elevated factor VIII, AT Ill functional, and Protein C. Ophthalmologic evaluation ruled out Susac syndrome. Repeat MRI demonstrated subacute frontoparietal infarct and lipoid appearance around vessels, which strongly suggested autoimmune etiology of his strokes. Given his lack of systemic symptoms, he was diagnosed with CNS vasculitis.

Setting: Tertiary care teaching hospital

Assessment/Results: On rheumatology follow up, Cytoxan and Azathioprine were initiated. On discharge he was ambulating with contact guard using straight cane.

Discussion (relevance): CNS vasculitis is a rare condition causing inflammation of small vessels in the spinal cord/ brain, leading to ischemia. Symptoms may manifest as impaired sensation, headaches, behavioral changes, cognitive decline and stroke. The wide variety of presentations and non-specific findings on imaging make this a diagnostic challenge. It is imperative to rule out other more likely differentials, including hyper-coagulable states and Susac syndrome. Management cyclophosphamide given in combination with corticosteroids followed by low risk immunosuppressive agents as maintenance therapy.

Conclusions: Physiatrists should recognize the qualities of CNS vasculitis and consider it as a cause in cases of multiple strokes in multiple hemispheres. CNS vasculitis is a rare condition with varying presentation, but its diagnosis is critical as it significantly alters management and treatment strategies compared to other cerebrovascular disorders