A Case of Polyarteritis Nodosa Associated with Vertebral Artery Vasculitis Treated Successfully with Tocilizumab and Cyclophosphamide

Figure 10

Neck imaging before and after treatment. (a) CTA coronal reformats demonstrating bilateral vertebral arteries prior to treatment. There is focal stenosis at C2-3 with poststenotic dilatation on the left side (arrowhead); the caliber of the right vertebral artery is maintained. (b) Left vertebral sagittal MRA after treatment demonstrating resolution of stenosis and poststenotic dilatation (thick blue arrow). (c) Axial MRI of cervical spine through C2 before treatment demonstrated marked adventitial thickening of bilateral vertebral arteries and focal stenosis at C2-C3 on the left side (arrow) and cervical myositis (arrowhead). (d) Posttreatment images demonstrated improvement in the adventitial thickening of bilateral vertebral arteries with improvement in the caliber of the artery at C2-3 (arrow). Note that there is complete resolution of muscular edema (arrowhead).

(a)

(b)

(c)

(d)