Primary Angiitis of the CNS Follow-up

Updated: Nov 03, 2016
  • Author: Mazen Noufal, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Follow-up

Further Outpatient Care

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  • When initially abnormal, brain MRI and CSF examination can be used with clinical findings to evaluate patient’s response to treatment.

  • Patients taking cyclophosphamide should be evaluated periodically for signs of drug toxicity. CBC should be performed every 2 weeks. The dose should be reduced or the drug should be temporarily held in case of leucopenia (WBC < 4000) or absolute neutropenia (neutrophils < 2000).

  • Patients, especially elderly patients, taking steroids should be given vitamin D and calcium supplements for bone mineral loss, and H2 blockers or proton-pump inhibitors for peptic ulcer disease. Blood glucose should also be monitored closely to detect iatrogenic diabetes.

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Further Inpatient Care

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  • Other comorbidities such as hypertension, diabetes, hypercholesterolemia, and heart diseases should be treated appropriately.

  • Antiplatelet aggregation agents should be given to patients with ischemic lesions, unless contraindicated.

  • Confusion, agitation, seizures, headache, nausea, and vomiting should be treated symptomatically.

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Complications

Complications for primary angiitis of the CNS are nonspecific. Patients who are immobile due to neurologic deficits are at higher risk for pneumonia, decubitus ulcers, and deep venous thrombosis (DVT). Complications of steroids and immunosuppressants are mentioned above in Further Outpatient Care.

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Prognosis

Prognosis of primary CNS angiitis is usually guarded, even with appropriate therapy. Prognosis is good in benign angiopathy of the CNS and postpartum CNS angiopathy, but these diagnoses are usually confirmed only in retrospect.

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Patient Education

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  • Patients should be educated about the chronic nature of the disease, and about the potential toxic side effects of steroids and immunosuppressants.

  • Patients should also be educated about the importance of controlling other cerebrovascular risk factors, such as hypertension, diabetes, hyperlipidemia, and smoking.

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