6.4.3 Headache attributed to secondary angiitis of the central nervous system (SACNS)

Identification: Male patient, 45 years old, previously healthy.

History of Present Illness: The patient sought medical attention due to a severe, pulsatile headache lasting approximately 3 weeks. The pain was diffuse, progressively worsening, and associated with episodes of nausea and vomiting. He also reported transient visual disturbances and difficulty concentrating. He denied fever, weight loss, or systemic symptoms.

Past Medical History: No relevant history. Denied continuous medication use or history of autoimmune diseases.

Physical Examination:

Neurological: Mild mental confusion, without motor or sensory focal deficits. Reflexes normal and symmetrical.

General: No signs of infection or skin changes.

Complementary Exams:

Cranial Magnetic Resonance Imaging (MRI): Revealed multiple areas of hyperintensity in the white matter, suggestive of vasculitis.

Cerebral Angiography: Segmental and irregular stenoses in medium and small caliber arteries, compatible with vasculitis.

Cerebrospinal Fluid (CSF): Mild lymphocytic pleocytosis and increased proteins, with no evidence of infection.

Inflammatory Markers: Elevated ESR and CRP.