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Review
. 2025 Feb;46(2):633-650.
doi: 10.1007/s10072-024-07935-5. Epub 2024 Dec 12.

Post-infectious central nervous system vasculitides in adults: an underdiagnosed and treatable disease : Part I. Overview

Marialuisa Zedde  1 , Rocco Quatrale  2 , Vincenzo Andreone  3 , Francesca Romana Pezzella  4 , Giuseppe Micieli  5 , Pietro Cortelli  6   7 , Massimo Del Sette  8 , Rosario Pascarella  9
Affiliations
Review

Post-infectious central nervous system vasculitides in adults: an underdiagnosed and treatable disease : Part I. Overview

Marialuisa Zedde et al. Neurol Sci. 2025 Feb.

Abstract

Introduction: The differential diagnosis of Primary Central Nervous System Angiitis (PACNS) is complex and includes several inflammatory and non-inflammatory conditions. Among the first ones, post-infectious CNS vasculitides represent a relevant topic and they are often underdiagnosed.

Aims: The main aim of this review is to summarize the clinical and neuroimaging features of post-infectious vasculitides, highlighting the diagnostic clues and the need to carefully consider them in the differential diagnosis of PACNS.

Findings: Several infectious agents (viruses, bacteria, fungi and parasites) can be involved in documented post-infectious vasculitides, often with a pathological confirmation. Post-infectious vasculitides involve not only immunocompromised hosts but also immunocompetent people and the diagnosis might be complicated by the lack of close time relationship between infections and neuro-logical symptoms, as in Varicella Zoster Virus (VZV) related vasculopathy in adults. Several complications may occur, ranging from ischemic to hemorrhagic stroke, from arterial to venous thrombosis, from large to small vessel involvement, often simultaneously.

Conclusions: Post-infectious vasculitides are caused by a broad spectrum of microorganisms and they should be carefully considered in the differential diagnosis of some neurological pictures and neuroradiologicals findings in immunocompetent adults too.

Keywords: Angiitis; Angiography; CNS; CSF; DSA; HRVWI; MRI; Mycotic aneurysm; PACNS; Post-infectious; Stroke; Syphilis; VZV.

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Conflict of interest statement

Declarations. Ethical approval: Not applicable. Competing interests: The authors have no competing interests to declare that are relevant to the content of this article.

References

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