Granulomatous angiitis of the brain. An inflammatory reaction of diverse etiology
D. S. Younger, A. P. Hays, J. C. Brust and L. P. Rowland
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY.
Granulomatous angiitis of the brain (GAB) is defined histologically by
granulomatous inflammation of intracranial blood vessels. We have studied
four patients with autopsy-proved GAB who had, respectively, Hodgkin's
lymphoma, herpes zoster, neurosarcoidosis, and no associated illness.
Headache, fever, or mental change was followed by hemiparesis or
quadriparesis, coma, and death in all four patients. There were no
diagnostic findings from cerebral computed tomograms, cerebrospinal fluid,
or cerebral angiograms; the diagnosis was established only by postmortem
examination. Vasculitis was limited to the brain in all four patients, and
involved large arteries, small arteries and veins, or both large and small
vessels. Differences in etiology and different particulars of the
pathologic conditions imply that GAB is a nonspecific reaction, not a
unique disease. The diagnosis, moreover, cannot be proved without
histologic confirmation. A biopsy specimen is the only way to ascertain the
diagnosis in living patients.
