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(Stroke. 1999;30:1651-1656.)
© 1999 American Heart Association, Inc.

Original Contributions

Angiitis of the Central Nervous System After Allogeneic Bone Marrow Transplantation?

Claudio S. Padovan, MD; Karl Bise, MD; Joachim Hahn, MD; Petra Sostak, PhD, MD; Ernst Holler, MD; Hans-Jochem Kolb, MD Andreas Straube, MD

From the Departments of Neurology (C.S.P., P.S., A.S.), Neuropathology (K.B.), and Internal Medicine III (J.H., E.H., H-J.K.), Klinikum Großhadern, Ludwig-Maximilians University, Munich, Germany.

Correspondence to Dr Claudio S. Padovan, Department of Neurology, Klinikum Großhadern, 81366 Munich, Germany. E-mail padovan{at}brain.nefo.med.uni-muenchen.de

Background and Purpose—There is only limited information about late neurological complications after bone marrow transplantation (BMT). The purpose of this study is to describe a cerebral angiitis-like syndrome after allogeneic BMT.

Methods—Clinical and diagnostic findings of 5 BMT patients with chronic graft versus host disease and neuropathological data of 1 patient were reported.

Results—In the described patients, focal neurological signs and neuropsychological abnormalities occurred years after BMT. MRI revealed periventricular white matter lesions, lacunar or territorial infarctions, leukoencephalopathy, and hemorrhages. Angiitis of the central nervous system was confirmed in 1 patient at autopsy, and an angiitis-like syndrome was suspected in the other patients because of the clinical course and response to treatment. Three patients received cyclophosphamide and steroids (2 improved, 1 died), 1 patient improved after steroids alone, and 1 patient without immunosuppressive therapy deteriorated further.

Conclusions—–We propose that an angiitis-like syndrome of the central nervous system can be a neurological manifestation of graft versus host disease, which should be considered a possible cause of cerebral ischemic episodes and pathological MRI scans in BMT patients with graft versus host disease.

Key Words: angiitis • bone marrow transplantation • cerebral infarction • cerebrovascular disorders • complications • graft vs host disease • white matter

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