The primary vasculitis of the central nervous system is still a controversial subject and in constant study for a better understanding of all its aspects. It is a pathophysiology disease that is not yet fully understood, and with probable immunological and biological mechanisms of very high complexity, which go beyond the current technical and scientific limits. Its clinical manifestations are challenging even for the most experienced neurologists, which requires, in addition to academic knowledge, a unique ability to interpret clinically and to weigh the results presented in complementary tests. This is because we do not have any non-invasive diagnostic tool that confirms, or discards, with full security, the possibility of VPSNC. In practice, the confirmatory examination is considered the gold standard and is still the brain biopsy, which is usually performed only in exceptional cases.