A case of juvenile cerebral infraction with mild headache, aphasia and apraxia because of primary angiitis of the central nerve system requiring differentiation from arterial dissection.

Abstract

  The case was a 34-year-old man. After noticing sudden and slight frontal pain, motor aphasia and ideational apraxia occurred. MRI revealed a new infarction in the left transverse temporal gyrus～insular gyrus, and MRA revealed occlusion of the left M2. Suspected cerebral artery dissection was detected and blood vessel wall imaging showed that the T1 hyperintensity was high on the second day of illness, but the hyperintensity disappeared on the seventh day. Contrast-enhanced T1 vessel wall imaging showed a contrast-enhanced effect, and primary angiitis of the central nerve system was diagnosed. After 4 weeks of treatment with oral prednisolone, the contrast effect disappeared and the vascular occlusion gradually improved. Even after tapering off prednisolone, there is no recurrence and vascular stenosis continues to disappear. Even in cases where arterial dissection is suspected, it is necessary to follow the signal changes in the blood vessel wall imaging and consider primary angiitis of the central nerve system.