Abstract Number: Esoc2026a92 Cerebral Vasculitis on Imaging: Insights From a 10-Year Case Series

Abstract Background and aims Cerebral vasculitis is defined as an inflammatory process affecting small- and medium-caliber blood vessels, involving both the arterial and venous systems. It may occur as a primary disorder confined to the central nervous system or as a secondary manifestation of systemic vasculitis. Early recognition is essential due to its potential reversibility with appropriate treatment. Methods We report a series of six patients, aged 32 to 70 years, with clinical and neuroradiological findings compatible with cerebral vasculitis, evaluated at Juan Ramón Jiménez Hospital between 2014 and 2024. All patients underwent clinical, laboratory, and imaging studies, including MRI and angiographic techniques. Results The most frequent clinical presentation was acute cerebrovascular syndrome. Half of the patients presented conventional cardiovascular risk factors such as hypertension, diabetes mellitus, or dyslipidemia, and one-third were active smokers. Two-thirds of the patients showed clinical improvement following immunosuppressive therapy. Only one-third presented autoimmune markers suggestive of systemic disease. Neuroimaging consistently demonstrated gliosis and leukoencephalomalacia, findings indicative of microvascular involvement. Two patients were ultimately diagnosed with systemic vasculitis—one post-radiotherapy and one lupus-associated—whereas the remaining four fulfilled Calabrese’s criteria for probable primary angiitis of the central nervous system. Conclusions This case series highlights the diagnostic value of non-invasive neuroimaging in the evaluation of cerebral vasculitis. The combination of radiological features and clinical presentation may allow the diagnosis of probable primary CNS vasculitis when invasive testing is not feasible or conclusive. Imaging remains a key tool in differentiating primary from secondary forms and in guiding early therapeutic decisions. Conflict of interest Hayar El Mouhajir: Nothing to disclose, Jose Maria Fernandez Velasco: nothing to disclose, Gonzalo Torres Sanchez: nothing to disclose