Cerebral large artery stenosis and occlusion in POEMS syndrome

• Published in: BMC neurology Vol. 21; no. 1; pp. 1 - 9
• Main Authors: Sugiyama, Atsuhiko, Yokota, Hajime, Misawa, Sonoko, Mukai, Hiroki, Sekiguchi, Yukari, Koide, Kyosuke, Suichi, Tomoki, Matsushima, Jun, Kishimoto, Takashi, Tanei, Zen-ichi, Saito, Yuko, Ito, Shoichi, Kuwabara, Satoshi
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 24-06-2021; BioMed Central; BMC
• Subjects: Angiography; Arteries; Autopsy; Blood diseases; Carotid artery; Castleman disease; Cerebral blood flow; Cerebral infarction; Cerebrovascular disease; Complications and side effects; Computed tomography; Computed tomography angiography; Edema; Endocrine disorders; Hypertension; Ischemia; Laboratories; Magnetic resonance angiography; Medical imaging; Multivariate analysis; Patients; Peripheral neuropathy; Polyneuropathy; Regression analysis; Risk factors; Statistics; Stenosis; Variables; Vascular diseases; Vascular endothelial growth factor; Vasospasm; Veins & arteries; Vertebrae; Japan
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-021-02260-2

Background This study aimed to investigate the frequency and risk factors for cerebral artery stenosis and occlusion in patients with polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome. Methods We reviewed results of magnetic resonance angiography (MRA) or computed tomography angiography (CTA) in 61 patients with POEMS syndrome seen between 2010 and 2017. Stenosis or occlusion was assessed in the initial MRA/CTA. Multivariate analysis was used to identify risk factors for artery stenosis/occlusion. In an autopsy case, pathologic examination was conducted of the occluded middle cerebral arteries. Results Stenosis (> 50 %) or occlusion of the major cerebral arteries was found in 29 (47.5 %) patients on the initial MRA/CTA. The internal carotid artery was involved most frequently (32.8 %), followed by the anterior (21.3 %) and middle (16.4 %) cerebral arteries. The basilar (1.3 %) and vertebral (3.6 %) arteries were rarely affected. Cerebral infarction developed in eight (13.1 %) patients. The serum vascular endothelial growth factor (VEGF) level was an independent predictor for stenosis/occlusion (odds ratio, 1.228; 95 % confidence interval, 1.042-1.447; P = 0.014). An autopsy study showed occluded middle cerebral arteries by fibrous and myxomatous thickening of intima with splitting of the internal elastic lamina. Follow-up MRA in 23 patients showed improved, worsened, and unchanged stenosis in 20.7 %, 8.7 %, and 69.6 %, respectively. Conclusions Cerebral large-vessel stenosis or occlusion is frequently seen in approximately half of patients with POEMS syndrome. Vasculopathy was related to serum VEGF levels and thereby disease activity. Assessment of cerebral vessels is recommended in these patients to improve management. Keywords: Magnetic resonance angiography, Computed tomography angiography, Cerebral infarction, Vasospasm, Castleman disease, Vascular endothelial growth factor