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To the Editor: Primary angiitis of the central nervous system (PACNS) is a vasculitis affecting small to medium-size arteries of any part of the brain, spinal cord, and meninges, resulting in highly variable and nonspecific manifestations. This can pose a significant diagnostic challenge because the clinical and radiological features of PACNS can mimic a number of other disorders. We describe a patient who presented with clinical and radiological manifestations compatible with PACNS but in whom brain biopsy disclosed a strikingly different diagnosis.A 50-year-old woman presented in January 2009 with a 2-month history of impaired gait associated with bilateral leg weakness, which progressed rapidly over the 10 days prior to her admission to the extent that she was unable to walk independently. Examination revealed positive upper motor neuron signs in the lower legs and some positive cerebellar signs. Laboratory examination revealed normocytic normochromic anemia (hemoglobin 9.7 g/dl; normal 12–16 g/dl) and markedly raised inflammatory markers [C-reactive protein (CRP) 92 mg/l; normal < 5 mg/l; erythrocyte sedimentation rate (ESR) 110 mm/h; normal < 10 mm/h]. … Address correspondence to Dr. M. Haroon, Department of Rheumatology, Bone and Joint Unit, St. Vincent’s University Hospital, Dublin, Ireland. E-mail: mharoon301{at}hotmail.com

Central Nervous System Vasculitis: All That Glitters Is Not Gold