%PDF-1.4
%
38 0 obj
<>
endobj
87 0 obj
<>stream
Acrobat Distiller 4.05 for Macintosh
2004-11-22T18:14:40Z
2024-03-28T19:36:13-07:00
QuarkXPressª: LaserWriter 8.5.1 8.5.1
2024-03-28T19:36:13-07:00
application/pdf
Heather
200648.march
uuid:39fdd974-1dd2-11b2-0a00-550827bd7200
uuid:39fdd976-1dd2-11b2-0a00-880000000000
endstream
endobj
36 0 obj
<>
endobj
39 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>>
endobj
1 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>>
endobj
4 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/Type/Page>>
endobj
11 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/Type/Page>>
endobj
16 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/Type/Page>>
endobj
22 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>>
endobj
25 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>>
endobj
28 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>>
endobj
110 0 obj
[113 0 R]
endobj
111 0 obj
<>stream
1 g
/GS0 gs
0 792 m
0 792 l
f
q
-1 793 614 -794 re
W n
q
0 792.06 612 -792 re
W n
BT
/CS0 cs 0 0 0 sc
/T1_0 1 Tf
-0.00011 Tc 0.02499 Tw 8 0 0 8 57 714.5293 Tm
[(12.)-875.1 (V)59.8 (illablanca JP)110.7 (, Martin NA, Jahan R, et al. )17.7 (V)128.9 (olume rendered helical)]TJ
2.175 -1.25 Td
[(CT)-257.3 (angiography in detection and characterization of intracranial)]TJ
0 -1.25 TD
[(aneurysms. J Neurosur)17.7 (g 2000;93:254-64.)]TJ
-2.175 -1.25 Td
[(13.)-875.1 (Rubin GD, Beaulieu CF)79.7 (, )54.8 (Ar)17.7 (giro )17.7 (V)128.9 (, et al. Perspective volume)]TJ
2.175 -1.25 Td
[(rendering of CT)-257.3 (and MR images: applications for endoscopic)]TJ
T*
(imaging. Radiology 1996;199:321-30.)Tj
-2.175 -1.25 Td
[(14.)-875.1 (Fraser F)73.9 (A, Zimbler SM. Hindbrain stroke in children caused by)]TJ
2.175 -1.25 Td
(extracranial vertebral artery trauma. Stroke 1975;6:153-9.)Tj
-2.175 -1.25 Td
[(15.)-875.1 (Ouvrier RA, Hopkins IJ. Occlusive disease of the vertebro-basilar)]TJ
2.175 -1.25 Td
(arterial system in childhood. Dev Med Child Neurol 1970;)Tj
0 Tc 0 Tw T*
(12:186-92.)Tj
-0.00011 Tc 0.02499 Tw -2.175 -1.25 Td
[(16.)-875.1 (DeV)59.7 (ivo DC, Farrell FW)91.7 (. )17.7 (V)110.8 (ertebrobasilar occlusive disease in)]TJ
2.175 -1.25 Td
[(children. )54.8 (Arch Neurol 1972;26:278-81.)]TJ
30.825 15 Td
[(17.)-875.1 (Cupps )17.7 (TR, Moore PM, Fauci )54.8 (AS. Isolated angiitis of the central)]TJ
2.175 -1.25 Td
[(nervous system. )54.8 (Am J Med 1983;74:97-106.)]TJ
-2.175 -1.25 Td
[(18.)-875.1 (Langford CA, Sneller MC, Hof)17.7 (fman GS. Methotrexate use in)]TJ
2.175 -1.25 Td
[(systemic vasculitis. Rheum Dis Clin North )54.8 (Am 1997;23:841-53.)]TJ
-2.175 -1.25 Td
[(19.)-875.1 (Calabrese LH, Gragg LA, Furlan )54.8 (AJ. Benign angiopathy: a distinct)]TJ
2.175 -1.25 Td
(subset of angiographically defined primary angiitis of the central)Tj
T*
(nervous systems. J Rheumatol 1993;20:2043-50.)Tj
-0.0298 Tw -2.175 -1.25 Td
[(20.)-875.1 (W)79.9 (oolfenden AR, )-37.1 (T)69.9 (ong )-54.8 (DC, )-54.8 (Marks )-54.8 (MP)110.7 (, Ali AO, Albers )-54.8 (GW)91.7 (.)]TJ
0.02499 Tw 2.175 -1.25 Td
(Angiographically defined primary angiitis of the CNS: is it really)Tj
T*
(benign? Neurology 1998;51:183-8.)Tj
ET
/CS0 CS 0 0 0 SC
54 54 m
558 54 l
S
BT
/T1_1 1 Tf
8 0 0 8 54.5 35.9844 Tm
[(Gallagher)110.7 (, et al: Childhood P)128.8 (ACNS)]TJ
0 Tc 0 Tw 61.4375 -0.0313 Td
(623)Tj
ET
1 1 1 sc
102.36 58.99 407.5 -10.83 re
f*
0.5 w
102.36 58.99 407.5 -10.83 re
S
Q
Q
q
0 0 612 792 re
W n
BT
0 g
/GS1 gs
/T1_2 8 Tf
120.092 51 Td
(Personal non-commercial use only. The Journal of Rheumatology Copyright\
\251 2001. All rights reserved.)Tj
ET
Q
BT
0 g
/GS1 gs
/T1_3 1 Tf
10 0 0 10 540 17 Tm
( )Tj
0 0.48627 0.77255 rg
/GS1 gs
-7.22298 0 Td
(www.jrheum.org)Tj
0 g
/GS1 gs
-16.72996 0 Td
(Downloaded on March 28, 2024 from )Tj
ET
endstream
endobj
47 0 obj
<>
endobj
41 0 obj
<>
endobj
69 0 obj
<>
endobj
91 0 obj
<>
endobj
64 0 obj
<>
endobj
112 0 obj
<>
endobj
42 0 obj
[/CalRGB<>]
endobj
113 0 obj
<>
endobj
114 0 obj
<>
endobj
107 0 obj
[115 0 R]
endobj
108 0 obj
<>stream
1 g
/GS0 gs
0 792 m
0 792 l
f
q
-1 793 614 -794 re
W n
q
0 792.06 612 -792 re
W n
/CS0 CS 0 0 0 SC
54 54 m
558 54 l
S
BT
/CS0 cs 0 0 0 sc
/T1_0 1 Tf
-0.00011 Tc 0.02499 Tw 8 0 0 8 424.3613 35.9844 Tm
(The Journal of Rheumatology 2001; 28:3)Tj
0 Tc 0 Tw -46.2952 -0.0313 Td
(622)Tj
ET
1 1 1 sc
103.36 58.99 407.5 -10.83 re
f*
0.5 w
103.36 58.99 407.5 -10.83 re
S
BT
0 0 0 sc
/T1_1 1 Tf
-0.00011 Tc 0.1049 Tw 10 0 0 10 54 713.1616 Tm
(patients and for followup of vasculitis involving the distal)Tj
-0.01331 Tw 0 -1.2 TD
[(circulation. CT)79.7 (A)-181.8 (is appropriate for followup of patients with)]TJ
-0.00011 Tw T*
[(lar)17.7 (ge and medium-size vessel involvement, although further)]TJ
0.0565 Tw T*
(studies are required to fully establish its role in the evalua-)Tj
0.02499 Tw T*
(tion and monitoring of CNS vasculitis.)Tj
0.008 Tc 0.3669 Tw 1.2 -1.2 Td
(Our observations suggest that, in contrast to adult)Tj
-0.00011 Tc 0.01579 Tw -1.2 -1.2 Td
(patients, both cerebral hemorrhage and posterior circulation)Tj
0.1248 Tw T*
[(involvement may be more common in childhood P)91.7 (ACNS.)]TJ
0.09351 Tw T*
[(T)69.9 (wo of the 10 cases reviewed presented with hemorrhagic)]TJ
0.0011 Tw T*
(strokes and 3/10 had posterior circulation involvement. One)Tj
0.0609 Tw T*
(of our patients presented with isolated posterior circulation)Tj
0.01579 Tw T*
(disease. Isolated posterior circulation vasculitis represents a)Tj
0.2699 Tw T*
(unique diagnostic challenge because of similarities with)Tj
0.07291 Tw T*
(occlusive disease of the vertebrobasilar system. Eight chil-)Tj
0.2057 Tw T*
[(dren have been reported with this entity)64.8 (, 2 secondary to)]TJ
0.2876 Tw T*
(sepsis, 2 with history of trauma, and 5 from unknown)Tj
0 Tw T*
(causes)Tj
6.5 0 0 6.5 80.0937 524.4615 Tm
(14-16)Tj
0.35989 Tw 10 0 0 10 95.2566 521.1616 Tm
(. In one case report, atlantoaxial subluxation)Tj
0.0706 Tw -4.1257 -1.2 Td
(causing occlusion at C1\3202 bilaterally led to bilateral verte-)Tj
0.0056 Tw T*
(bral artery occlusion, basilar artery abnormalities, and hind-)Tj
0.3192 Tw T*
[(brain stroke. )17.7 (These findings were similar to the initial)]TJ
-0.02431 Tw T*
(abnormalities in Patient 3, who had no history of trauma and)Tj
0.02499 Tw T*
(a stable cervical spine.)Tj
0.00101 Tc 0.3739 Tw 1.2 -1.21 Td
(There have been no controlled therapeutic trials in)Tj
0 Tc 0.0677 Tw -1.2 -1.21 Td
[(P)91.9 (ACNS. Cupps, )]TJ
/T1_0 1 Tf
-0.00011 Tc [0.4 (et al)]TJ
/T1_1 1 Tf
8.957 0 Td
(first reported improved survival with)Tj
-0.0063 Tw -8.957 -1.21 Td
(the combination of corticosteroids and cyclophosphamide)Tj
0 Tc 0 Tw 6.5 0 0 6.5 285.0001 428.1617 Tm
(17)Tj
10 0 0 10 291.5 424.8617 Tm
(.)Tj
-0.00011 Tc 0.12849 Tw -23.75 -1.21 Td
(All our patients received corticosteroids, and 4/5 received)Tj
0.0406 Tw 0 -1.21 TD
(cyclophosphamide. Patient 5 was initially treated only with)Tj
0.0199 Tc 0.36211 Tw T*
(corticosteroids and exhibited significant angiographic)Tj
-0.00011 Tc 0.063 Tw T*
[(progression 3 weeks later)54.8 (. Patient 2 received a less aggres-)]TJ
0.13589 Tw T*
(sive regimen including low dose prednisone \(7.5 mg/day\))Tj
0.1263 Tw T*
(and a single dose of cyclophosphamide because of uncer-)Tj
0.0963 Tw T*
(tainty with the diagnosis. She progressed, then was lost to)Tj
-0.0219 Tw T*
(followup. Patient 4 exhibited continued angiographic abnor-)Tj
0.3438 Tw T*
(malities 4 months after cyclophosphamide was discon-)Tj
0.0199 Tc 0.47479 Tw T*
(tinued, and clinical deterioration that responded to)Tj
-0.00011 Tc 0.19119 Tw T*
(retreatment with cyclophosphamide. Patient 3 had angio-)Tj
0.3735 Tw T*
(graphic progression while taking bimonthly cyclophos-)Tj
0.2271 Tw T*
(phamide that stabilized following initiation of daily oral)Tj
0.2261 Tw T*
[(dosing. )17.8 (The optimal duration of therapy in P)91.7 (ACNS also)]TJ
0.00259 Tc 0.3723 Tw T*
[(remains unclear)54.8 (. )54.8 (Alhalabi and Moore performed serial)]TJ
-0.00011 Tc 0.15089 Tw T*
[(angiography on 19 adult patients with P)91.7 (ACNS and found)]TJ
0.13091 Tw T*
(continued improvements in angiograms in patients treated)Tj
-0.0305 Tw T*
(longer than one year)Tj
0 Tc 0 Tw 6.5 0 0 6.5 134.9901 210.3618 Tm
(10)Tj
-0.00011 Tc -0.0305 Tw 10 0 0 10 141.4901 207.0618 Tm
[(. )17.7 (T)69.9 (wo of our patients were transitioned)]TJ
0.13631 Tw -8.749 -1.21 Td
(from cyclophosphamide to MTX after 12 and 19 months,)Tj
0.0614 Tw T*
[(respectively)64.9 (, based on its potential benefit in other vasculi-)]TJ
0 Tw T*
(tides)Tj
0 Tc 6.5 0 0 6.5 72.8843 174.0619 Tm
(18)Tj
-0.00011 Tc 0.00459 Tw 10 0 0 10 79.3842 170.7618 Tm
[(. One of these patients is now of)17.7 (f all immunosuppres-)]TJ
-0.0369 Tw -2.5384 -1.21 Td
[(sive therapy)64.8 (, and both remain clinically and radiographically)]TJ
0.29401 Tw T*
[(stable. )54.8 (As noted, one patient who received less than 8)]TJ
0.2328 Tw T*
[(months of cyclophosphamide therapy relapsed. )17.7 (T)69.9 (ogether)39.7 (,)]TJ
0.0451 Tw T*
(our experience suggests that optimal management for pedi-)Tj
0.02589 Tw T*
[(atric P)91.7 (ACNS should consist of combined corticosteroid and)]TJ
0.1312 Tw T*
(cytotoxic therapy in association with careful angiographic)Tj
0.0168 Tw T*
[(\(or possibly CT)-249.1 (angiography\) monitoring for a minimum of)]TJ
0 Tc 0.02499 Tw T*
(12 months.)Tj
-0.00011 Tc 0.0415 Tw 27.6 63.92 Td
[(Finally)64.8 (, Calabrese, )]TJ
/T1_0 1 Tf
(et al)Tj
/T1_1 1 Tf
9.8755 0 Td
(have proposed the classification)Tj
-0.03329 Tw -11.0756 -1.2 Td
(of benign angiopathy of the CNS \(BACNS\) for patients with)Tj
0.244 Tw 0 -1.2 TD
(a vasculitic picture on angiogram and normal or mildly)Tj
0.19611 Tw T*
(abnormal CSF studies)Tj
0 Tc 0 Tw 6.5 0 0 6.5 410.2455 680.4615 Tm
(19)Tj
-0.00011 Tc 0.1962 Tw 10 0 0 10 416.7454 677.1616 Tm
[(. )17.8 (These authors suggest that such)]TJ
-0.0145 Tw -9.8745 -1.2 Td
(findings correlate with a monophasic, benign clinical course)Tj
0.0013 Tw T*
(despite an initial presentation with focal neurologic deficits,)Tj
0.0845 Tw T*
(and therefore they suggest use of less aggressive immuno-)Tj
0.1118 Tw T*
(suppression in this clinical context. Four of our 5 patients)Tj
-0.03259 Tw T*
(had normal CSF studies and thus would have met criteria for)Tj
0.2684 Tw T*
[(BACNS. It should be noted, however)39.7 (, that lar)17.7 (ge vessel)]TJ
0.35159 Tw T*
(involvement, vessel occlusion, and/or unilateral disease)Tj
0.05409 Tw T*
(\(present in 2 of 5 our patients\) are rarely reported in adults)Tj
0.2612 Tw T*
(with BACNS. In further contrast to the observations in)Tj
0.0174 Tw T*
(adults, each of these patients exhibited radiographic disease)Tj
0.1916 Tw T*
(progression, and 2 exhibited clinical progression prior to)Tj
-0.01151 Tw T*
[(any therapy)64.8 (. )17.8 (Thus, while a normal CSF and focal neurologic)]TJ
0.27879 Tw T*
(deficit may be associated with a monophasic course in)Tj
-0.00031 Tw T*
[(adults, this is unlikely to be the case in children. )17.7 (The benign)]TJ
0.00661 Tw T*
(nature of this disorder in adults has also recently been ques-)Tj
0 Tw T*
(tioned)Tj
0 Tc 6.5 0 0 6.5 342.9951 488.4616 Tm
(20)Tj
-0.00011 Tc 0.0791 Tw 10 0 0 10 349.4951 485.1616 Tm
(. Our experience, in association with previous case)Tj
0.0435 Tw -3.1495 -1.2 Td
[(reports, suggests that P)91.7 (ACNS in children is associated with)]TJ
0.02609 Tw T*
[(a significant potential for morbidity and mortality)64.8 (. Children)]TJ
0.1169 Tw T*
(with frequent or severe headaches and/or focal neurologic)Tj
0.1817 Tw T*
(deficits should be thoroughly evaluated. Patients meeting)Tj
0.0249 Tw T*
[(criteria for P)91.7 (ACNS should be treated aggressively)64.8 (.)]TJ
/T1_2 1 Tf
0 Tw 0 -2.4 TD
(REFERENCES)Tj
/T1_1 1 Tf
0.02499 Tw 8 0 0 8 325 391.1616 Tm
[(1.)-875.1 (Lie JT)73.9 (. Primary \(granulomatous\) angiitis of the central nervous)]TJ
1.675 -1.25 Td
[(system: )54.8 (A)-220.1 (clinicopathologic analysis of 15 new cases and review of)]TJ
0 -1.25 TD
(the literature. Hum Pathol 1992;23:164-71.)Tj
-1.675 -1.25 Td
[(2.)-875.1 (LaMancusa J, Steiman G. Suspected isolated angiitis causing stroke)]TJ
1.675 -1.25 Td
(in a child [letter]. Stroke 1990;21:1380.)Tj
-1.675 -1.2375 Td
[(3.)-875.1 (Barron )17.7 (TF)79.7 (, Ostrov BE, Zimmerman RA, Packer RJ. Isolated)]TJ
1.675 -1.2375 Td
[(angiitis of CNS: )17.7 (T)35 (reatment with pulse cyclophosphamide. Pediatr)]TJ
0 -1.2375 TD
(Neurol 1993;9:73-5.)Tj
-1.675 -1.2375 Td
[(4.)-875.1 (Matsell DG, Keene DL, Jimenez C, Humphreys P)110.7 (. Isolated angiitis)]TJ
1.675 -1.2375 Td
(of the central nervous system in childhood. Can J Neurol Sci)Tj
0 Tc 0 Tw T*
(1990;17:151-4.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.2375 Td
[(5.)-875.1 (Calabrese LH, Mallek JA. Primary angiitis of the central nervous)]TJ
1.675 -1.2375 Td
(system; Report of 8 new cases, review of the literature, and)Tj
T*
(proposal for diagnostic criteria. Medicine 1987;67:20-39.)Tj
-1.675 -1.2375 Td
[(6.)-875.1 (Duna GF)79.7 (, Calabrese LH. Limitations of invasive modalities in the)]TJ
1.675 -1.2375 Td
(diagnosis of primary angiitis of the central nervous system. )Tj
T*
(J Rheumatol 1995;22:662-7.)Tj
-1.675 -1.2375 Td
[(7.)-875.1 (Calabrese LH, Duna GF)79.7 (, Lie JT)73.9 (. )17.7 (V)110.8 (asculitis in the central nervous)]TJ
1.675 -1.2375 Td
[(system. )54.8 (Arthritis Rheum 1997;40:1)36.7 (189-201.)]TJ
-1.675 -1.2375 Td
[(8.)-875.1 (Stone JH, Pomper MG, Roubenof)17.7 (f R, Miller )17.7 (TJ, Hellman DB.)]TJ
1.675 -1.2375 Td
(Sensitivities of noninvasive tests for central nervous system)Tj
T*
[(vasculitis: )54.8 (A)-220.1 (comparison of lumbar puncture, computed)]TJ
T*
[(tomography)64.8 (, and magnetic resonance imaging. J Rheumatol)]TJ
0 Tc 0 Tw T*
(1994;21:1277-82.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.25 Td
[(9.)-875.1 (Hellman DB, Roubenof)17.7 (f R, Healy RA, )17.7 (W)79.9 (ang H. Central nervous)]TJ
1.675 -1.25 Td
(system angiography: safety and predictors of a positive result in)Tj
0 -1.25 TD
(125 consecutive patients evaluated for possible vasculitis. )Tj
T*
(J Rheumatol 1992;19:568-72.)Tj
-2.175 -1.25 Td
[(10.)-875.1 (Alhalabi M, Moore P)110.7 (. Serial angiography in isolated angiitis of the)]TJ
2.175 -1.25 Td
(central nervous system. Neurology 1994;44:1221-6.)Tj
-2.1381 -1.25 Td
[(1)36.8 (1)-0.1 (.)-875.1 (Heiserman JE, Dean BL, Hodak JA, et al. Neurologic)]TJ
2.1381 -1.25 Td
[(complications of cerebral angiography)64.8 (. )54.8 (AJNR )54.8 (Am J Neuroradiol)]TJ
0 Tc 0 Tw T*
(1994;15:1401-7.)Tj
ET
Q
Q
q
0 0 612 792 re
W n
BT
0 g
/GS1 gs
/T1_3 8 Tf
120.092 51 Td
(Personal non-commercial use only. The Journal of Rheumatology Copyright\
\251 2001. All rights reserved.)Tj
ET
Q
BT
0 g
/GS1 gs
/T1_4 1 Tf
10 0 0 10 540 17 Tm
( )Tj
0 0.48627 0.77255 rg
/GS1 gs
-7.22298 0 Td
(www.jrheum.org)Tj
0 g
/GS1 gs
-16.72996 0 Td
(Downloaded on March 28, 2024 from )Tj
ET
endstream
endobj
50 0 obj
<>
endobj
109 0 obj
<>
endobj
115 0 obj
<>
endobj
116 0 obj
<>
endobj
104 0 obj
[117 0 R]
endobj
105 0 obj
<>stream
1 g
/GS0 gs
0 792 m
0 792 l
f
q
-1 793 614 -794 re
W n
q
0 792.06 612 -792 re
W n
BT
/CS0 cs 0 0 0 sc
/T1_0 1 Tf
-0.00011 Tc 0.1403 Tw 10 0 0 10 54 135.1671 Tm
(angiography is a safer alternative to conventional angiog-)Tj
0.0013 Tw 0 -1.2 TD
(raphy for neurovascular imaging, as it does not require arte-)Tj
0.006 Tw T*
(rial puncture or intraarterial catheter manipulation)Tj
-0.0567 Tc 0 Tw 6.5 0 0 6.5 254.4694 114.4671 Tm
(11)Tj
-0.00011 Tc -0.0117 Tw 10 0 0 10 260.6007 111.1671 Tm
[(. T)69.9 (wo )-17.7 (of)]TJ
0.12421 Tw -20.6601 -1.2 Td
(our patients exhibited excellent correlation in the findings)Tj
0.1908 Tw T*
[(between CT)-423 (angiography and cerebral angiography)64.8 (. CT)79.7 (A)]TJ
0.0705 Tw T*
(has recently been shown to have sensitivity and specificity)Tj
0.07739 Tw 26.4 6 Td
(equal to digital subtractive angiography in the detection of)Tj
0.04041 Tw T*
(small vascular lesions)Tj
0 Tc 0 Tw 6.5 0 0 6.5 406.5541 126.4671 Tm
(12)Tj
-0.00011 Tc 0.04041 Tw 10 0 0 10 413.054 123.1671 Tm
[(. However)39.7 (, the resolution with CT)79.7 (A)]TJ
0.08949 Tw -9.5054 -1.2 Td
(is lower and is limited by poor visualization of very small)Tj
-0.0002 Tc 0 Tw T*
(arteries)Tj
0 Tc 6.5 0 0 6.5 347.4165 102.4671 Tm
(13)Tj
-0.00011 Tc 0.0649 Tw 10 0 0 10 353.9164 99.1671 Tm
[(. CT)79.7 (A)-260 (also has the potential limitation of showing)]TJ
-0.02029 Tw -3.5916 -1.2 Td
[(arteries and veins in the same image. )17.8 (W)79.9 (e advocate the use of)]TJ
0.3064 Tw T*
(conventional angiography in the initial diagnosis of all)Tj
/T1_1 1 Tf
0 Tc 0.02499 Tw 8 0 0 8 55 713.5302 Tm
[(T)91.9 (able 1. )]TJ
/T1_0 1 Tf
-0.00011 Tc [0.3 (Presentation, treatment, and outcome of current and previously reported \
P)91.7 (ACNS pediatric cases.)]TJ
0 Tw 0 -2.5 TD
[(Patient)-2473 (Age,)-3534.3 (Presenting)-2779.2 (Duration)-3870.9 (CSF)-4596.3 (MRI/A)-4111.7 (Angiogram)-3945.9 (T)35 (reatment)-5301.4 (Clinical)]TJ
0.02499 Tw 5.25 -1.25 Td
[(yrs,)-3978.4 (Symptoms)-23521.8 (at Diagnosis)-12879.1 (Outcome)]TJ
0 Tw -5.25 -2.5 Td
[(1)-4750.1 (1)36.8 (1)-4487 (Seizure,)-3752.1 (Acute)-5037.6 (88)]TJ
/T1_2 1 Tf
0 Tc 31.5 0 Td
(\002)Tj
/T1_0 1 Tf
-0.00011 Tc 0.8778 0 Td
[(ICA)-4400.6 (Segmental)-4279.2 (Steroids,)-5848 (Minimal)]TJ
0.02499 Tw -21.6778 -1.25 Td
[(hemiparesis)-9649.5 (rbc, 0)-11073.5 (narrowing L)-3505.1 (CTX, )54.8 (ASA)-4905.5 (hemiparesis)]TJ
0 Tw 14.425 -1.25 Td
[(wbc)-11709.3 (ICA, )]TJ
/T1_2 1 Tf
0 Tc 15.6217 0 Td
(\002)Tj
/T1_0 1 Tf
-0.0002 Tc 6.2533 0 Td
(MTX)Tj
-0.00011 Tc 0.02499 Tw -21.875 -1.25 Td
[(nl pro)-10989.5 (filling MCA,)]TJ
0 Tw 13.375 -1.25 Td
(ACA)Tj
0.0251 Tw -38.5 -1.25 Td
[(2)-4750.1 (8)-4950.1 (HA,)-5306.3 (2 wks)-5039.3 (2130)-4375.1 (Par)19.7 (-occ)-3966.9 (Segmental)-4279.2 (Steroids)-6098 (Hemiparesis)]TJ
10.7 -1.25 Td
[(dizziness,)-10510.1 (rbc)-5098.5 (bleed)-4834.6 (narrowing L)]TJ
0 -1.25 TD
[(falling)-11815 (0 wbc)-3934.3 (\(CT\))-5056.7 (ACA, Bas, R)]TJ
14.425 -1.25 Td
[(nl pro)-10989.5 (PCA)-220.2 (& ICA,)]TJ
13.375 -1.25 Td
[(occ L)-238.2 (PCA,)]TJ
T*
(angular br L)Tj
0 Tw T*
(MCA)Tj
0.02499 Tw -38.5 -1.25 Td
[(3)-4750.1 (5)-4950.1 (HA, emesis,)-2060.1 (5 mo)-5372.3 (nl)-5597.3 (3 small)-4058.8 (B )17.7 (V)110.8 (ert, Bas)-3885.6 (Steroids)-6098 (Asymptomatic)]TJ
-0.0298 Tw 10.7 -1.25 Td
[(vertigo)-17967.8 (infarcts,)-3752.3 (Stenoses/occ)-3335.3 (CTX, ASA,)]TJ
-0.0002 Tc 0 Tw 20.8 -1.25 Td
[(focal)-13501.9 (warfarin,)]TJ
T*
[(basilar)-12835.2 (MTX)]TJ
-0.00011 Tc T*
(stenosis)Tj
0.02499 Tw -31.5 -2.5 Td
[(4)-4750.1 (7)-4950.1 (HA,)-5306.3 (Subacute)-3759.8 (nl)-5597.3 (BG, IC,)-3836.4 (Narrowing B)-3227 (Steroids,)-5848 (Hemiparesis)]TJ
-0.0298 Tw 10.7 -1.25 Td
[(hemiparesis)-2224.5 (HA,)-12106.3 (Fronto-)-4000.8 (ICA, )-54.8 (R ACA,)-3005.5 (CTX, AZT)73.9 (,)]TJ
-0.0002 Tc 0.0251 Tw 7 -1.25 Td
[(acute)-11690.8 (temp)-5000.7 (& MCA)-5169.5 (ASA)]TJ
-0.00011 Tc 0 Tw T*
[(hemiparesis)-9024.5 (infarcts,)-12252.3 (RPT)]TJ
/T1_2 1 Tf
-0.0002 Tc 13.8 -1.25 Td
(\002\001)Tj
/T1_0 1 Tf
-0.00011 Tc 0.02499 Tw 0.8778 0 Td
[(MCA)-12344.5 (steroid, CTX)]TJ
-32.3778 -1.25 Td
[(5)-4750.1 (7)-4950.1 (HA, seizure,)-1950.2 (Acute)-5037.6 (nl)-5597.3 (Fronto-)-4000.8 (Irregular R)-4061.5 (Steroids,)-5848 (Hemiparesis,)]TJ
10.7 -1.25 Td
[(hemiparesis)-16024.5 (par)39.7 (, BG)-3849.4 (MCA,)-5972.3 (CTX, )54.9 (ASA)-4905.5 (impulsivity)]TJ
20.8 -1.25 Td
[(infarcts)-4002.3 (narrowing R)]TJ
0 Tw 7 -1.25 Td
(ACA)Tj
0.02499 Tw -38.5 -1.25 Td
[(6*)-4250.1 (5)-4950.1 (Recurrent)-3058.2 (2 mo)-5372.3 (nl)-5597.3 (BG)-5611.2 (L)-238.1 (MCA)-5373.3 (Steroids, 4)-5073 (Asymptomatic)]TJ
0 Tw 10.7 -1.25 Td
[(hemiparesis,)-15774.5 (infarct)-4391.2 (beading)-5334.6 (mo)]TJ
T*
(aphasia)Tj
0.02499 Tw -10.7 -1.25 Td
[(7*)-4250.1 (12)-4450.1 (HA, emesis)-2310.1 (Chronic)-4203.7 (nl)-5597.3 (Parietal)-3946.4 (Focal)-6278.7 (Steroids)-6098 (Asymptomatic)]TJ
17.7 -1.25 Td
[(migraines,)-9607.2 (bleed)-4834.6 (segmental)-4446.1 (12+ mo)]TJ
0 Tw T*
(acute )Tj
/T1_2 1 Tf
0 Tc 2.3844 0 Td
(\003)Tj
/T1_0 1 Tf
-0.00011 Tc 0.02499 Tw 18.4156 0 Td
[(narrowing)-4391 (CTX 18 mo)]TJ
T*
(ant & post)Tj
-0.0002 Tc 0 Tw T*
(circ)Tj
-0.00011 Tc 0.02499 Tw -38.5 -1.25 Td
[(8*)-4250.1 (8)-4950.1 (Facial hemi-)-1949.7 (3/7)-6147.3 (nl)-5597.3 (Multi)-4777.7 (nl)-7722.3 (Steroids 6)-5323 (Deceased)]TJ
10.7 -1.25 Td
[(paresis. HA,)-2005.1 (mo)-12522.3 (hyperintense)-10391.2 (weeks RPT)]TJ
T*
[(hemianeste-)-15969.5 (signals)-12722.8 (Tx? 14)]TJ
T*
[(sia, diplopia)-31387.2 (mo)]TJ
36.3 -1.25 Td
(CTX? 14 mo)Tj
-47 -1.25 Td
[(9*)-4250.1 (12)-4450.1 (Hemiparesis)-2002.5 (3 days)-4817.3 (N/A)-4653.4 (N/A)-5278.4 (Stenosis,)-4916.8 (Steroids)-6098 (Asymptomatic)]TJ
10.7 -1.25 Td
[(nystagmus,)-23272.8 (ectasia B,)]TJ
T*
[(hemianesthesia)-21691.7 (PCA, MCA)]TJ
-10.7 -1.25 Td
[(10)-4250.1 (10)-4450.1 (HA, aphasia,)-1783 (4 wks)-5039.3 (N/A)-4653.4 (N/A)-5278.4 (Stenosis,)-4916.8 (None)-7209.3 (Asymptomatic)]TJ
10.7 -1.25 Td
[(hemiparesis)-23024.5 (ectasia B,)]TJ
0 Tw T*
[(confusion)-23856.7 (MCA)]TJ
-0.0024 Tw -10.7 -2.5 Td
[(nl: normal, B: bilateral, Par: parietal, Bas: basilar)39.7 (, Occ: occipital, temp: temporal, BG: basal ganglia, IC: internal capsul\
e,)]TJ
-0.0002 Tc -0.0023 Tw 48.4847 0 Td
[( MCA: middle cerebral artery)64.8 (, )54.8 (ACA:)]TJ
-0.00011 Tc 0.032 Tw -48.4847 -1.25 Td
[(anterior cerebral artery)64.8 (, PCA: posterior cerebral artery)64.8 (, ICA: internal carotid artery)64.9 (, CTX: cyclophosphamide, MTX: methotrexat)0.4 (e, AZT: azathioprine, )54.8 (ASA:)]TJ
0.02499 Tw T*
(acetylsalicyclic acid, )Tj
/T1_2 1 Tf
0 Tc 0 Tw [0.1 (\003)]TJ
/T1_0 1 Tf
-0.00011 Tc 0.02499 Tw [0.2 (: increase, )]TJ
/T1_2 1 Tf
0 Tc 0 Tw (\002)Tj
/T1_0 1 Tf
-0.00011 Tc 0.02499 Tw [0.2 (: decrease, N/A: not available.)]TJ
T*
(*Previous reports in the literature, see references 2,3,4,5.)Tj
ET
/CS0 CS 0 0 0 SC
0.5 w
54 708 m
561 708 l
54 207 m
560 207 l
55 677 m
558 677 l
S
1 w
54 54 m
558 54 l
S
BT
/T1_1 1 Tf
8 0 0 8 54.5 35.9844 Tm
[(Gallagher)110.7 (, et al: Childhood P)128.8 (ACNS)]TJ
0 Tc 0 Tw 61.4375 -0.0313 Td
(621)Tj
ET
1 1 1 sc
102.36 58.99 407.5 -10.83 re
f*
0.5 w
102.36 58.99 407.5 -10.83 re
S
Q
Q
q
0 0 612 792 re
W n
BT
0 g
/GS1 gs
/T1_3 8 Tf
120.092 51 Td
(Personal non-commercial use only. The Journal of Rheumatology Copyright\
\251 2001. All rights reserved.)Tj
ET
Q
BT
0 g
/GS1 gs
/T1_4 1 Tf
10 0 0 10 540 17 Tm
( )Tj
0 0.48627 0.77255 rg
/GS1 gs
-7.22298 0 Td
(www.jrheum.org)Tj
0 g
/GS1 gs
-16.72996 0 Td
(Downloaded on March 28, 2024 from )Tj
ET
endstream
endobj
32 0 obj
<>
endobj
33 0 obj
<>
endobj
34 0 obj
<>stream
HTPn -Hͥqq)NcX[HC GNJefmt&E&L#n~
a8hR**+,-a-NagagQc4nĴpG.!@B*ûMZyz[
t+@HPˣlO+Lt^}!fV.HSg:ǘׅ%qY*
0 o
endstream
endobj
106 0 obj
<>
endobj
117 0 obj
<>
endobj
118 0 obj
<>
endobj
101 0 obj
[119 0 R]
endobj
102 0 obj
<>stream
1 g
/GS0 gs
0 792 m
0 792 l
f
q
-1 793 614 -794 re
W n
q
0 792.06 612 -792 re
W n
/CS0 CS 0 0 0 SC
54 54 m
558 54 l
S
BT
/CS0 cs 0 0 0 sc
/T1_0 1 Tf
-0.00011 Tc 0.02499 Tw 8 0 0 8 424.3613 35.9844 Tm
(The Journal of Rheumatology 2001; 28:3)Tj
0 Tc 0 Tw -46.2952 -0.0313 Td
(620)Tj
ET
1 1 1 sc
103.36 58.99 407.5 -10.83 re
f*
0.5 w
103.36 58.99 407.5 -10.83 re
S
BT
0 0 0 sc
/T1_1 1 Tf
-0.00011 Tc 0.19591 Tw 10 0 0 10 54 207.162 Tm
(because it occurred beyond the expected time period for)Tj
0.02499 Tw 0 -1.2 TD
(such complications.)Tj
0.0041 Tw 1.2 -1.2 Td
(At present, monitoring of abnormalities due to continued)Tj
0.30679 Tw -1.2 -1.2 Td
(inflammation within CNS vessels requires serial angio-)Tj
-0.0135 Tw T*
[(graphy)64.8 (. In addition, relying on the development of new clin-)]TJ
0.12309 Tw T*
[(ical changes is dif)17.7 (ficult to justify in patients whose initial)]TJ
0.1494 Tw T*
[(presentation was a CV)128.8 (A. For these reasons, repeat angio-)]TJ
0.07829 Tw T*
(graphy were recommended in all and were obtained in 4/5)Tj
0.075 Tw T*
(of our patients. Patient 3 was evaluated using serial angio-)Tj
0.0401 Tw T*
(graphy because of the severity of stenosis at a critical loca-)Tj
0.1684 Tw T*
(tion. Overall, these angiographic studies revealed gradual)Tj
0.27209 Tw T*
[(improvement over time in association with therapy)64.8 (. CT)]TJ
ET
q
246.9978 0 0 320.1571 53 398.8429 cm
1.2 TL /Im0 Do
Q
q
184.9984 0 0 308.1573 320 410.8427 cm
1.2 TL /Im1 Do
Q
q
198.9982 0 0 316.7972 321 74.2028 cm
1.2 TL /Im2 Do
Q
BT
/T1_2 1 Tf
0 Tc 0 Tw 12 0 0 12 57 383.2549 Tm
(A)Tj
39.25 3.0833 Td
(B)Tj
-0.1667 -26.8333 Td
(C)Tj
/T1_0 1 Tf
-0.00011 Tc 0.033 Tw 8 0 0 8 54 353.5296 Tm
[(Figur)36.8 (e 2.)]TJ
/T1_1 1 Tf
3.9455 0 Td
[(A. MRI )17.7 (T2 weighted axial image in Patient 5 showing extensive)]TJ
-0.0126 Tw -3.9455 -1.25 Td
(infarction in the deep nuclear and cortical territory of the right middl\
e cere-)Tj
0.3289 Tw 0 -1.25 TD
[(bral artery)64.8 (. B. Cerebral angiography: right common carotid injection)]TJ
0.0162 Tw T*
[(reveals occlusion of the majority of the right MCA)-211.4 (branches \(arrow\). Only)]TJ
0.006 Tw T*
[(the posterior parietal branch of the MCA)-201.2 (remains patent \(arrowheads\). )17.7 (The)]TJ
0.08459 Tw T*
(right anterior cerebral artery is also not visible. C. Cerebral angiogra\
phy:)Tj
0.1398 Tw T*
(right common carotid injection showing complete occlusion of the right)Tj
0.1208 Tw T*
[(MCA)-316 (\(lar)17.7 (ge arrow\). )17.7 (There is filling of the right posterior cerebral artery)]TJ
0.35561 Tw T*
(\(small arrow\) through a patent right posterior communicating artery)Tj
0.0936 Tw T*
[(\(arrowhead\). )17.7 (The previous patent parietal branch of the MCA)-288.8 (is now not)]TJ
0 Tw T*
(visible.)Tj
ET
Q
Q
q
0 0 612 792 re
W n
BT
0 g
/GS1 gs
/T1_3 8 Tf
120.092 51 Td
(Personal non-commercial use only. The Journal of Rheumatology Copyright\
\251 2001. All rights reserved.)Tj
ET
Q
BT
0 g
/GS1 gs
/T1_4 1 Tf
10 0 0 10 540 17 Tm
( )Tj
0 0.48627 0.77255 rg
/GS1 gs
-7.22298 0 Td
(www.jrheum.org)Tj
0 g
/GS1 gs
-16.72996 0 Td
(Downloaded on March 28, 2024 from )Tj
ET
endstream
endobj
19 0 obj
<>stream
Adobe d C
#"""#'''''''''' A "
s !1AQa"q2B#R3b$r%C4Scs5D'6Tdt&
EFVU(eufv7GWgw8HXhx)9IYiy*:JZjz ? *뚹u͛lp gq(;lEIkYkfm3iRcE?Fq%>ʎU̟*bw`60_ii
4<м #6/KƁ(`E~Z&j1/VU{rT0/JcOf߲kO[yWi!~Tעzn@5d~FI2hDstrmTѥ1jɆVE1P3W`V%_VMYmx 0j{7\a.>W%$aÁj#q( +sZrN_^^^9Td v>7/9ӠlL@o$4OcdkQνISvIl( |uMs"9YыT~- .'״J6ߗ_xKL%W,߯
(j^V7èi@x_SS:<)2]q~_h}Zb҉?/](] S 6Q x1F)scE͡Uwt3I|*. G> (9t8[ͱ;(;( #}yOld Ƣd HpG>l2zkG[432=4zǣ}YL?t:o-y^ɸ hbn;0V4s|h8
R8ĜԹu?5Q@PR}v[Nd_]մ Kf`j$[/G|*" N_FycTНl5pvhx}h f91ռ?؝OH?QF&^ǵ Ck;n7SXxLn٫^[W/34#*j8jrC/lV8˰U^o,#0("*"Zua'0Ճi1hlNJ*AˊygF5MNs[6E ~R'[oSOIY(:{r7 a>#PpM֙[ӕɩL395aE"9!'ca[caQ;`kBj<4p*7.+VVZ?*lDԥH
5iek) !jV#WոjjW?1*3-H@eE+%\dqGO٩dAў7
b?NhO'/~wk_uFi͕S]Ma>&ƞ-E݈epʵ :kz=C0Y٤
a%㣯Z00z}j0,kOr@|[/X7Q0LnnfVHJ\iV B()P~7Y>1*eqR~8LU"zdFQ6qixXѬk ܂3Іk< V`\Eem#ԕ_꺭=Iu<8G#]PyH&'Hn2Yl?3<(0+ S9->M
M*^#(S0