cns vasculitis?

[andreas2142]

Hi there wondering if anyone can help,for the last few years i have been suffering from a variety of distressing symptoms which sometimes can wax and wane.I had tia attack 4 years ago in brainstem region and eventually they diagnosed hole in heart which they said was probable cause.However i have had numerous strange symptoms since then including dizziness,sometimes ver brief acute vertigo,inbalance,pins and needles in upper limbs which can be there for few months then vanish,headaches ,visual disturbances which only last for about a second,stiffish neck which feels burning sometimes,muscle and joint pain and fatigue as well as a diagnosed horners syndrome that came and went after 2 months to name a few as well as a few mysterious attacks of angioedema.I have had numerous tests done which include 3 mri scans(1 was an mri/mra and another was done with contrast dye)1 ct scan and i ct angiography done to look at blood vessels in brain,3 Lumbar punctures and numerous blood tests performed.all the scans were completely normal except for 1tiny high signal region in the left centrum semi ovale which was present in all scans and unchanged on them all.All blood work normal including ANA,compilment andantibodies to extractible nuclear antigensnegative,liver and kidney function normal,hiv negative.The only abnormal test is my lumbar puncture which has shown a mild but very slightly increasing pleocytosis(6wbc,17wbc,26wbc over 3 years but csf protein is normal as well as all other csf indicators),what else can cause mild pleocytosis but all other tests normal,thanks paolo.

[andreas2142]

Hi there thanks for reply as far as i am aware i only had few rbc in csf so that couldn't account for pleocytosis,and all other tests performed on it were normal and i think they did test for fungal meningitis causes too,my own g.p seems to think there is nothing too much too worry about in short term as it seems to be a very slow growing process but she also suggested because of my history of inflammatory conditions  such as ulcerative colitis and myagic encephalopathy for years that this could lead to benign pleocytosis,also is a passing  partial horner's syndrome linked to vasculitis or chiari malformation,thanks.

[CCF-Neuro-M.D.-PW]

Although one can see a mild pleocytosis in CNS vasculitis the extensive CNS vascular testing seems to be all negative, pointing away from CNS vasculitis.

CSF pleocytosis has a very large number of causes. It must also be interpreted in ratio with the number of red cells (about 1:800) as a traumatic spinal tap with 30,000 red cells/mm would have about 26 white cells/mm just be there being some normal blood there/ Also the type of white blood cells present can give clues to the diagnosis, this is not specified in your post

Some possibilities might that may have evaded detection include sarcoidosis, an indolent chronic meningitis (such as fungal), reaction to a viral meningitis or encephalitis, Lyme disease, a drug induced reaction (actually quite common including drugs like NSAIDS and antibiotics), local inflammation from ie a growth or vascular structure, among other rarer causes

Your symptoms though are not necessarily tied to the CSF WBC , and as without any other abnormalities, it should be interpreted  with caution. Good luck