Clinical Images: High‐resolution vessel wall magnetic resonance imaging detecting central nervous system vasculitis

The patient, a 38-year-old man with ulcerative colitis, presented with recurrent ischemic strokes over three years. Extensive evaluations, including autoimmune serologic tests, a thrombophilia workup, and a cerebrospinal fluid analysis, were unremarkable. During a recent episode of right facial numbness, slurred speech, and headache, high-resolution vessel wall magnetic resonance imaging (HR-VWI) revealed mild luminal narrowing and concentric wall enhancement in bilateral distal posterior cerebral arteries (A and B, arrows) and in the left posterior temporal branch of the middle cerebral artery (C, arrow). The findings were highly suggestive of central nervous system (CNS) vasculitis. HR-VWI enables direct visualization of intracranial vessel walls and can detect subtle mural inflammation even when luminal imaging appears normal. It is particularly useful for differentiating CNS vasculitis from mimics such as reversible cerebral vasoconstriction syndrome. In this patient, the HR-VWI findings, combined with clinical correlation and exclusion of alternative diagnoses, led to the diagnosis of CNS vasculitis associated with ulcerative colitis. Early recognition and prompt immunosuppressive treatment are critical to prevent recurrent cerebrovascular events. This case highlights the utility of HR-VWI in evaluating cryptogenic strokes and detecting inflammatory vasculopathies in patients with underlying autoimmune diseases. The authors thank the patient for her consent to share this case and the medical staff involved in her care. Disclosure Form: Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.