A 45-year-old woman was admitted with right-sided weakness, dysarthria, and arterial hypertension lasting over 24 h. She was diagnosed with a left ischemic stroke. The initial CT scan revealed hypodense lesions that were suggestive of a demyelinating disease (see Appendix A, Annex 1). The course proved unfavorable, and the patient was admitted to the ICU due to an hypertensive emergency and altered level of consciousness. The CSF showed an increased protein concentration (see Appendix A, Annex 2). An MRI revealed multiple acute infarcts in the brain, cerebellum, and brainstem (Fig. 1, Appendix A, Annex 3). An MRI with contrast injection revealed segmental, homogeneous, and concentric enhancement of the vessel walls (Fig. 2). MRI angiography revealed multiple bilateral segmental stenoses (Fig. 3). Primary CNS vasculitis was diagnosed and corticosteroids were prescribed, but there was no response. The patient died ten days later due to generalized cerebral edema and brain death (see Appendix A, Annex 4).

Figure 1.

Diffusion MRI sequence showing bilateral acute-subacute cerebral infarcts.

Figure 2.

MRI with contrast injection: enhancement and concentric thickening of the basilar artery wall.

Figure 3.

Angio-MRI reconstruction showing multiple vascular strictures.