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A 55 year-old woman presented with headaches, confusion and multiple strokes.
Cerebral Angiogram: (Left) Right Internal Carotid Artery injection; (Right) Left Internal Carotid Artery injection; both AP views. Note the severe tapered narrowing of the left proximal anterior cerebral artery. This appearance is consistent with cerebral vasculitis, with can occur as an isolated syndrome or part of a more widespread system vasculitis. A similar appearance may occur from vasospasm following SAH. Often, brain and meningeal biopsy is needed to confirm the diagnosis. Cerebral vasculitis often presents with an encephalopathy and superimposed focal deficits from multiple ischemic strokes. The syndrome can be confused with embolic infarctions and arteriosclerotic intracranial disease, the latter which is more prominent in Asian and African-Americans rather than Caucasians.