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Semin Neurol 2011; 31(3): 286-306
DOI: 10.1055/s-0031-1287658
© Thieme Medical Publishers

Cerebrovascular Disease in Central Nervous System Infections

Felicia C. Chow1 , 2 , 3 , Christina M. Marra4 , Tracey A. Cho1 , 2 , 3
  • 1Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
  • 2Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
  • 3Harvard Medical School, Boston, Massachusetts
  • 4Department of Neurology, University of Washington, Seattle, Washington
Further Information

Publication History

Publication Date:
30 September 2011 (online)

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ABSTRACT

Cerebrovascular disease is a complication of a variety of infections affecting the central nervous system (CNS). Infection may cause vasculitis affecting primarily the vessels at the base of the brain in the setting of meningitis; an immune-mediated parainfectious process leading to vasospasm or thrombosis; or a hypercoagulable state in combination with endothelial dysfunction resulting from activation of inflammatory and procoagulant cascades. Although systemic signs and symptoms may be present to aid in the diagnosis, cerebral infarction secondary to infection may be indistinguishable from more typical causes of stroke. Confirmation of an infectious vasculitis may also be challenging, as brain biopsy, the gold standard for diagnosis, is rarely pursued. In many CNS infections, vascular complications portend a poor prognosis as they are often associated with devastating neurologic outcomes, including death, underscoring the importance of early recognition and appropriate therapy. In this review, we address bacterial, viral, fungal, and parasitic causes of cerebrovascular disease.

KEYWORDS

Stroke - vasculitis - vasculopathy - cerebrovascular - infection - meningitis - central nervous system

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Tracey A ChoM.D. 

MGH Neurology, 55 Fruit Street

Boston, MA 02114

Email: tcho@partners.org