Intravenous Methylprednisolone for Acute Right Middle Cerebral Artery Occlusion in Granulomatosis Polyangiitis: A Case Report

Tsubasa Watanabe; Nakako Tanaka-Mabuchi; Yuto Morishima; Takanori Hata; Ryosuke Ito; Sho Nakajima; Atsuhiko Shindo; Yuki Nakamura; Hideyuki Yoshioka; Koji Hashimoto; Kazumasa Shindo; Hiroyuki Kinouchi; Daiki Nakagomi; Yuji Ueno

doi:10.2169/internalmedicine.4873-24

Tsubasa Watanabe, Nakako Tanaka-Mabuchi, Yuto Morishima, Takanori Hata, Ryosuke Ito, Sho Nakajima, Atsuhiko Shindo, Yuki Nakamura, Hideyuki Yoshioka, Koji Hashimoto, Kazumasa Shindo, Hiroyuki Kinouchi, Daiki Nakagomi, Yuji Ueno

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Keywords: granulomatosis polyangiitis, cerebral infarction, vasculitis, middle cerebral artery occlusion

JOURNAL OPEN ACCESS Advance online publication

Article ID: 4873-24

DOI https://doi.org/10.2169/internalmedicine.4873-24

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Abstract

A 17-year-old Japanese woman diagnosed with granulomatosis with polyangiitis (GPA) and was treated with immunotherapy suddenly developed an impaired consciousness, left hemiplegia, and conjugate eye deviation to the right. Magnetic resonance imaging showed an acute cerebral infarction in the right striatum and right middle cerebral artery (MCA) occlusion. As her GPA had worsened recently, intravenous methylprednisolone (IVMP) was started. Immediately after IVMP was started, recanalization of the MCA was detected on repeat cerebral angiography. Aspirin and argatroban dissolved the residual thrombi. A combination of IVMP and antithrombotic therapy may be effective for large-vessel occlusions associated with GPA.

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