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Investigation

Authoring team

The systemic auto-antibodies and inflammatory markers are normal.

The chest radiograph is normal which should help distinguish cases of neurosarcoid and Churg-Strauss vasculitis.

MRI scanning of the brain reveals:

  • multiple white matter lesions
  • multiple cortical lesions
  • occasionally there may be large areas of high signal

The cerebrospinal fluid may show:

  • elevated protein
  • lymphocyte pleocytosis

Cerebral angiography may show:

  • irregular narrowing of intracranial arteries
  • blunt-ending of intracranial arteries

Brain biopsy shows:

  • inflammation of small arteries (100-500 microns)
  • lymphocyte infiltration
  • small numbers of giant cells
  • thrombosis of vessels corresponds to infarcted areas
  • there is variable meningeal involvement

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