Cerebral Vasculitis in a Middle - Aged Woman with Multiple Sclerosis and Interferon Treatment

Case Report

Austin J Clin Case Rep. 2016; 3(4): 1100.

Cerebral Vasculitis in a Middle - Aged Woman with Multiple Sclerosis and Interferon Treatment

Yeh PS¹*, Wu TC², Chen TY² and Chen HA³

¹Department of Neurology, Taipei Medical University, Taiwan

²Department of Radiology, Chi-Mei Medical Center, Taiwan

³Department of Medicine, Chi-Mei Medical Center, Taiwan

*Corresponding author: Poh-Shiow Yeh, Department of Neurology, Chi-Mei Medical Center and Department of Neurology, Taipei Medical University, Taiwan

Received: July 28, 2016; Accepted: September 14, 2016; Published: September 16, 2016


Cerebral vasculitis coexisting with multiple sclerosis is very rare. A middle aged woman was diagnosed to have multiple sclerosis from the typical clinical presentations, white matter lesions disclosed on brain magnetic resonance images and cerebrospinal fluid findings. She was treated with interferon to prevent the relapse of multiple sclerosis. The patient began to have various transient neurological deficits with ischemic-like cortical lesions shown on brain images 12 months after receiving the disease-modifying drug. Finally, the case developed bilateral and disseminated cortical ischemic lesions. Extensive cerebral vasculitis was confirmed by cerebral angiography, and there was no clinical evidence of infection and other systemic autoimmune disease. The clinical outcome was poor. Immunomodulating therapy can probably exacerbate or provoke other coexisting autoimmune diseases including vasculitis. The cerebral vasculitis should be considered among multiple sclerosis patients undergoing immunomodulating drug treatment when developing stroke or transient ischemic stroke like events.

Keywords: Cerebral vasculitis, Disease modifying therapy, Immunomodulating drug, Interferon, Multiple sclerosis


Multiple Sclerosis (MS) is an inflammatory demyelinating disease involving the central nervous system and characterized by repeated autoimmune attacks of various neurological deficits. Several Immunomodulating Drugs (IMD) including Interferon-β (IFN-β) are commonly used as disease modifying treatment for MS to prevent autoimmune attack and neurological damage. The major problems of IMD therapy in MS are the patient’s poor response to reduce relapse rate and immunotherapy related side-effects such as fever and flulike symptoms. It is well known that different autoimmune disorders can exist in one patient. The most common autoimmune disorders among patients with MS are Hashimoto’s thyroiditis, psoriasis, and inflammatory bowel disease [1]. Cerebral vasculitis coincident with MS is very rare. The coexistence of various autoimmune disorders in the same patient suggests that the patient may carry a general susceptibility to autoimmune dysfunction [1]. In recent years, it has become well-known that IMD can cause immune dysregulation and provoke other autoimmune disease [2-4]. Here we illustrate an unusual clinical experience in which cerebral vasculitis was noted in a MS patient after receiving interferon as the disease modifying therapy.

Case Presentation

A middle aged woman who had been healthy before suffered from acute sensorimotor deficits of the left limbs and recovered soon after conservative treatment at a community hospital although white matter lesions were shown on her Magnetic Resonance Imaging (MRI). Two months later, she developed another episode of acute decline in mental-motor responses and was referred to our hospital. The initial MRI showed multiple white matter lesions in bilateral deep white matter and periventricular regions (Figure 1). The cerebrospinal fluid analysis revealed elevated protein and positive oligoclonal bands. Immunological and infection surveys were normal. Under the clinical diagnosis of Multiple Sclerosis (MS), she received intravenous methylprednisolone pulse therapy and then immunomodulation therapy with subcutaneous INF- β1a. She responded well to these therapies and the follow-up images showed regression of the white matter lesions.