CNS Vasculitis Associated with Waldenström Macroglobulinemia
Relevant brain and blood vessel imaging highlighting vasculitic cause of multifocal strokes. MRI on day of admission with diffusion scan (a) significant for curvilinear increased signal in the cortical surface of both anterior parietal lobes extending into the postcentral gyrus on left, with additional foci of restricted diffusion within the periventricular white matter in both hemispheres (left > right). Subtle signal abnormalities are seen along cortical surface primarily in both anterior parietal lobes on FLAIR imaging (b). MRI performed 2 days after initial imaging showed progression of FLAIR signal (d) abnormalities with reduced diffusion (c) consistent with multifocal cortical infarcts involving the posterior frontal, occipital, left temporal, left frontal, and deep bilateral white matter. Cerebral angiogram (e) showing multifocal distal small vessel moderate to severe vasculitis predominantly involving the posterior circulation. Arrows point to areas of vessel beading and irregularity.