HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Reichhart, M. D. Articles by Janzer, R. C. Search for Related Content PubMed PubMed Citation Articles by Reichhart, M. D. Articles by Janzer, R. C.

Early lacunar strokes complicating polyarteritis nodosa

Thrombotic microangiopathy

From the Departments of Neurology (Drs. Reichhart and Bogousslavsky), and Pathology (Dr. Janzer), University Hospital of Lausanne, Lausanne, Switzerland.

Address correspondence and reprint requests to Dr. J. Bogousslavsky, Service de Neurologie, CHUV 1011 Lausanne, Switzerland; e-mail: Julien.Bogousslavsky{at}chuv.hospvd.ch

OBJECTIVE: To determine the patterns and mechanisms of polyarteritis nodosa (PAN)–associated strokes (PANAS).

BACKGROUND: Strokes are reputed to be rare complications of PAN and to occur at a late stage (2 to 3 years). The cause of stroke is unknown but may be related either to atherosclerosis-like occlusive vasculopathy, caused possibly by hypertension or corticosteroid (CS) use, or to vasculitic arterial occlusion.

METHODS: Clinical and radiologic patterns, latencies, and current therapy at onset in 15 PANAS patients (4 of the authors’ and 11 published cases) were analyzed.

RESULTS: A lacunar stroke syndrome (11/15 cases, 73%) was the most frequent stroke pattern in PANAS (multiple, small, deep infarcts in 6, [55%], pontine lacunae in 3 [27%], and leukoaraiosis in 2 [18%]), followed by pure lobar hematoma and bilateral, possibly cardioembolic, large ischemic infarcts (2 cases each). A stroke latency shorter than that previously established (within 8 months in 73% of cases; mean latency, 6.5 months) and a close relationship between the use of CS and stroke in PAN also were found. Of the 77% of first-time or recurrent lacunar strokes that developed despite CS therapy, 80% appeared within 6 months and 50% within 3 weeks of CS initiation.

CONCLUSION: Early lacunar stroke syndrome, related to deep small- or pontine-penetrating artery thrombotic microangiopathy rather than vasculitis, was the most frequent PANAS pattern. This vasculopathy may be aggravated by corticosteroid (CS) therapy enhancement of either platelet thromboxane A₂ production or arterial wall fibrosis. Thus, antiplatelet drugs in association with CS may be advisable for preventing stroke occurrence or recurrence in PAN.

Key words: Polyarteritis nodosa—Periarteritis nodosa—Stroke

This article has been cited by other articles:

				L. Durelli, B. Ferrero, A. Oggero, E. Verdun, A. Ghezzi, E. Montanari, and M. Zaffaroni Thyroid Function and Autoimmunity during Interferon {beta}-1b Treatment: A Multicenter Prospective Study J. Clin. Endocrinol. Metab., August 1, 2001; 86(8): 3525 - 3532. [Abstract] [Full Text] [PDF]