Vasculitis from the point of view of a neurologist
by Dr. med. A.C. Arlt, Rheumaklinik Bad Bramstedt
The peripheral nervous system is concerned with vasculitis much more frequently than the brain, the spinal cord or the muscles.
Organs possibly involved in vasculitides are also the brain and the spinal cord (both known as CNS-illness) as well as nerve roots, peripheral nerves and muscles. Diagnosing such illnesses is one of the tasks of neurology. Depending on the underlying form of vasculitis the distributionals pattern of neurologic illnesses and the frequency of neurological complications differ a lot. The general experience with vasculitides can be summed up in saying that with vasculitides the imvolvement of the peripheral nerveous system is comparativley frequent whereas the brain, the spinal cord and the muscles are involved comparatively seldom.
A neurological and psychiatric examination and/or the patients' anamnesis may lead to taking an affection of parts of the nervous system or the muscles into consideration. Further examinations, then, will confirm or disapprove the suspected disease and are also carried through to better locate a suspected disease and lay hold of its dimension. The methods of additional examination which are used most frequently should be mentioned:
By Electroneurography the conductiive velocity of motor nerve fibres and sensitiv nerve fibres is measured. whereas by the use of neelde electrodes the electric activity of muscle cells is measured (Electromyographie). An Electroencephalography makes brain waves recognizable by use of surface electrodes. By looking closely at the potentials evoked either visually, accusticcally or somatosensoric the capacitiy of the leads of the sense organs is brought to light. Doppler-Sonography and Duplex-Sonography allow an evaluation the flow in the vessels of throat and brain and are depicted graphically. A Lumbal Puncture enables one to examine the nerve-fluid. Sometimes a biopsy of muscle tissue or peripheral nerves is taken to histologically back up the suspicion of a supsected vasculitis .
Medication is supposed to stop the inflammation
If an affetcion of the nervous system and/or the muscles has been proved the main focus is on the therapy of the basic illness, i.e. vasculitis. It is very rare in vasculitides to find exclusively separate parts of of the central or peripheral nervous system or the muscles, so the decision on the therapy to be chosen will rarely be made by the neurologist alone. The chice of the appropriate therapy will be based on the form of the vasculitis, its grade of activity and its extension (Which organs are involved? Do we fear fatal complicatons?). Normally a therapy will be started on medication with the aimof stopping any activity of the inflammation.
It is not the neurologist alone who decides on the therapy
Additional forms of specialized, neurologic therapy depend on the locality, the extent and the results of the illness' manifestation in every sinlge case. They include, for example, medicationmedication against epilepsy, medication regulating the blood coagulation, remedial gymnastics, ergotherapy, logopedics, physiotherapy, training of the brain's various capacities.