Rapidly Progressive Multifocal Cerebral Vasculitis Presenting With Bi-Hemispheric Stroke

Abstract

Vasculitis is a rare but important cause of stroke, often presenting with ischemic infarcts due to vascular inflammation and stenosis. While vasculitis-related strokes more commonly occur in younger patients without traditional vascular risk factors, their presentation is highly variable, leading to complex diagnostic and management considerations. Although bi-hemispheric infarcts are often associated with hypercoagulable states or embolic sources, they can also result from vasculitis. We present a unique case of a 38-year-old male with a history of multiple autoimmune conditions who developed rapidly progressive multifocal strokes associated with cerebral vasculitis of uncertain etiology. Despite aggressive medical management, including high-dose corticosteroids, the patient experienced worsening ischemic events and further neurological decline. This case highlights the diagnostic and therapeutic challenges of vasculitis-related stroke, emphasizing the need for early recognition, comprehensive evaluation, and tailored immunosuppressive strategies to improve patient outcomes.