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This case underscores the diagnostic complexity of PACNS and its treatment difficulties. Although a brain biopsy remains the gold standard for diagnosis, its invasiveness, potential to exacerbate neurological deficits, risk of bleeding and potential damage to surrounding brain tissue make it impractical for all patients. In this case, standard glucocorticoid and immunosuppressive therapies failed to halt disease progression, demonstrating PACNS\u2019s typically poor prognosis. This case highlights the urgent need for improved diagnostic strategies and novel treatments to achieve better clinical outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2025-266850","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T05:20:24Z","timestamp":1759900824000},"page":"e266850","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Differentiating primary angiitis of the central nervous system from paraneoplastic neurological syndrome"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0092-6367","authenticated-orcid":false,"given":"Anastasija","family":"Solodjankina","sequence":"first","affiliation":[{"name":"Neurology, Riga East University Hospital, R\u012bga Stradi\u0146\u0161 University, Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8056-7087","authenticated-orcid":false,"given":"Daina","family":"Pastare","sequence":"additional","affiliation":[{"name":"Neurology, Riga East University Hospital, R\u012bga Stradi\u0146\u0161 University, Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"2025100722201673000_18.10.e266850.1","unstructured":"Godasi R , Pang G , Chauhan S , et al . 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