PACNS

Primary Angiitis of the Central Nervous System (PACNS) is a rare, inflammatory disease that causes inflammation of the blood vessels in the brain and spinal cord. This condition can lead to strokes, cognitive changes, seizures, and neurological decline, even in the absence of other systemic illness.

At The Royal Buckinghamshire Hospital, we support adult patients recovering from stroke-like complications of PACNS through our specialist neurorehabilitation centre. Whether symptoms develop acutely or progressively, we offer personalised therapy focused on restoring independence, function, and confidence.

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What Is PACNS?

PACNS is a type of central nervous system vasculitis, meaning inflammation affects only the small and medium-sized blood vessels in the brain or spinal cord. Unlike secondary vasculitis (caused by autoimmune disease, infection or cancer), PACNS occurs without another known cause.

It is extremely rare and may present with a wide range of neurological symptoms that mimic other more common conditions such as:

• Stroke
• Brain tumour
• Multiple sclerosis
• Functional Neurological Disorder (FND)

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Signs and Symptoms

PACNS may present as either a sudden neurological event or a gradual decline in function. Symptoms may include:

• Sudden weakness or numbness (similar to a stroke)
• Headache (persistent or sudden onset)
• Seizures
• Cognitive difficulties (confusion, memory loss, slowed thinking)
• Gait disturbance or balance problems
• Personality or behavioural changes
• Visual disturbance
• Fatigue or brain fog

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How Is PACNS Diagnosed?

Diagnosis is challenging due to the rarity and overlapping symptoms. It often requires:

• MRI brain scan – showing areas of inflammation or stroke
• Cerebral angiography – to detect vessel narrowing or abnormalities
• Lumbar puncture – to examine cerebrospinal fluid for signs of inflammation
• Brain biopsy – occasionally needed to confirm diagnosis
• Exclusion of systemic vasculitis or infection

Early treatment usually involves immunosuppressive medications (e.g. steroids or cyclophosphamide), often coordinated by neurology and rheumatology teams.

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Our Rehabilitation Approach

At Royal Bucks, we support patients after stabilisation and acute treatment, when long-term rehabilitation is needed due to:

• Cognitive impairment
• Stroke-related weakness
• Fatigue and reduced stamina
• Speech or communication changes
• Balance and walking issues
• Functional neurological symptoms
• Psychological adjustment and trauma

Our multidisciplinary rehabilitation programme includes:

• Neurophysiotherapy – to improve mobility, balance and strength
• Occupational therapy – to support daily tasks, cognition, and fatigue management
• Speech and language therapy – where appropriate
• Education and pacing strategies – to help patients manage energy and improve quality of life

Explore Our Rehabilitation Centre
View Stroke Rehabilitation
Learn About Functional Neurological Disorder

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When to Consider Inpatient Rehab

Our inpatient service may be appropriate for patients:

• Recovering from stroke-like episodes or seizures caused by PACNS
• Experiencing long-term neurological complications
• Struggling with cognitive function, fatigue, or independence
• With co-existing anxiety, low mood, or functional overlay
• Needing coordinated therapy input to support return to daily life

We also provide family education and discharge planning to support long-term success beyond rehabilitation.