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Meningeal involvement in granulomatosis with polyangiitis
Afectación meníngea en granulomatosis con poliangitis
Andreia Brito
, Cátia Teixeira, David Ferreira
Corresponding author
Servicio de Medicina Interna, Centro Hospitalar Médio Tejo EPE, Abrantes, Spain
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Flores Ponzio, Christian E. Aguayo Jimenez, Ana L. Hernandez Barrón" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Irma I." "apellidos" => "Flores Ponzio" ] 1 => array:2 [ "nombre" => "Christian E." "apellidos" => "Aguayo Jimenez" ] 2 => array:2 [ "nombre" => "Ana L." "apellidos" => "Hernandez Barrón" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2603924923000071?idApp=UINPBA00004N" "url" => "/26039249/0000000600000002/v1_202304131830/S2603924923000071/v1_202304131830/es/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in medicine</span>" "titulo" => "Meningeal involvement in granulomatosis with polyangiitis" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Andreia Brito, Cátia Teixeira, David Ferreira" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Andreia" "apellidos" => "Brito" "email" => array:1 [ 0 => "andreia.brito@chmt.min-saude.pt" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cr0005" ] ] ] 1 => array:2 [ "nombre" => "Cátia" "apellidos" => "Teixeira" ] 2 => array:2 [ "nombre" => "David" "apellidos" => "Ferreira" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Centro Hospitalar Médio Tejo EPE, Abrantes, Spain" "identificador" => "af0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Afectación meníngea en granulomatosis con poliangitis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "f0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 716 "Ancho" => 709 "Tamanyo" => 47213 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">(Arrows): Gadolinium- enhanced axial T1-weighted MRI scan showing rihgt occipito-parietal subcortical edematous component.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">Granulomatosis with polyangiitis is a systemic disorder that is characterized by necrotizing vasculitis of small and medium vessels.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> The respiratory system is most affected in limited forms of the disease, however, lower respiratory system, systemic vasculitis, and necrotizing glomerulonephritis are the characteristic components of the disease triad.<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> Impact to the central nervous system is rare and may only occur with meningeal involvement.</p><p id="p0010" class="elsevierStylePara elsevierViewall">A 67 year-old caucasian female patient resorted to the emergency services reporting severe headache, fainting sensation, and a feeling of blocked ear, all of which within a two week evolution period.</p><p id="p0015" class="elsevierStylePara elsevierViewall">The patient has a relevant clinical history of granulomatosis with polyangiitis, diagnosed approximately 40 years ago, with impact restricted to the upper respiratory tract (nasal mucosa).</p><p id="p0020" class="elsevierStylePara elsevierViewall">A computerized tomography reveals right otomastoiditis, and ischemic leukoencephalopathy, thrombosis of right lateral sinus.</p><p id="p0025" class="elsevierStylePara elsevierViewall">For added clarify and confirmation, a Magnetic resonance imaging (MRI) with gadolinium was executed. T1 showed involvement of the central nervous system by granulomatosis with polyangiitis.</p><p id="p0030" class="elsevierStylePara elsevierViewall">Anomalous pachymeningeal dural enhancement and leptomeningeal involvement on occipital and parietal right lobes (<a class="elsevierStyleCrossRefs" href="#f0005">Fig. 1 and 2</a>, arrows), with homolateral occipito-parietal subcortical edematous component (<a class="elsevierStyleCrossRef" href="#f0015">Fig. 3</a>, arrows) and right otopathy (<a class="elsevierStyleCrossRef" href="#f0020">Fig. 4</a>, arrows).</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><elsevierMultimedia ident="f0010"></elsevierMultimedia><elsevierMultimedia ident="f0015"></elsevierMultimedia><elsevierMultimedia ident="f0020"></elsevierMultimedia><p id="p0035" class="elsevierStylePara elsevierViewall">The patient started treatment with corticosteroids 1mg/Kg/day for 4 weeks, along with rituximab, with significant improvements to the symptoms.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-02-10" "fechaAceptado" => "2023-02-28" "PalabrasClave" => array:1 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1632337" "palabras" => array:2 [ 0 => "Granulomatosis with polyangiitis" 1 => "Central Nervous System" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec1632336" "palabras" => array:1 [ 0 => "MRI" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "f0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 560 "Ancho" => 709 "Tamanyo" => 25717 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">(Arrows) T1-weighted MRI scan showing anomalous pachymeningeal dural enhancement and leptomeningeal involvement on occipital and parietal right lobe.</p>" ] ] 1 => array:8 [ "identificador" => "f0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 560 "Ancho" => 709 "Tamanyo" => 28867 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">(Arrows): Gadolinium- enhanced axial T1-weighted MRI scan showing anomalous pachymeningeal dural enhancement and leptomeningeal involvement on occipital and parietal right lobe.</p>" ] ] 2 => array:8 [ "identificador" => "f0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 716 "Ancho" => 709 "Tamanyo" => 47213 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">(Arrows): Gadolinium- enhanced axial T1-weighted MRI scan showing rihgt occipito-parietal subcortical edematous component.</p>" ] ] 3 => array:8 [ "identificador" => "f0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 712 "Ancho" => 591 "Tamanyo" => 34040 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">(Arrows) T1-weighted MRI scan showing right otomastoiditis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meningeal Involvement in Wegener Granulomatosis: Case Report and Review of the Literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A Soriano" 1 => "ML Vullo" 2 => "M Casale" 3 => "CC Quattrocchi" 4 => "A Afeltra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/039463201202500431" "Revista" => array:7 [ "tituloSerie" => "International Journal of Immunopathology and Pharmacology" "fecha" => "2012" "volumen" => "25" "numero" => "4" "paginaInicial" => "1137" "paginaFinal" => "1141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23298504" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bb0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granulkomatosis with polyangiitis (Wegner’s disease): An updated review of ocular disease manifestations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Burra Kubaisi" 1 => "Kawla Abu Samra" 2 => "C. Stephen Foster" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intratactable and Rare Diseases Research" "fecha" => "2016" "volumen" => "5" "numero" => "2" "paginaInicial" => "61" "paginaFinal" => "69" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/26039249/0000000600000002/v1_202304131830/S2603924923000083/v1_202304131830/en/main.assets" "Apartado" => array:4 [ "identificador" => "80822" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imagen en medicina" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/26039249/0000000600000002/v1_202304131830/S2603924923000083/v1_202304131830/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2603924923000083?idApp=UINPBA00004N" ]
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