Takayasu's disease presenting as convulsive syncope which had been misinterpreted as epilepsy: a case report

Abstract

Introduction: Takayasu's arteritis is a chronic vasculitis mainly involving the aorta and its main branches. The disease has protean clinical manifestation ranging from asymptomatic to catastrophic illness.

Case presentation: A 19-year-old woman of Asian origin was referred to our neurology out-patient department for the management of refractory seizures. She reported several episodes of a loss of consciousness with tonic posturing when she assumed an upright position, which was accompanied by constitutional symptoms. A clinical examination showed orthostatic hypotension and an investigation confirmed the diagnosis of Takayasu's disease with presentation as convulsive syncope.

Conclusion: Our case highlights the importance of a thorough clinical history and physical examination in order to distinguish events mimicking epileptic seizure. We also describe an unusual presentation of Takayasu's disease with convulsive syncope and systemic constitutional symptoms.

Figure 1

Color Doppler images of right (A) and left (B) common carotid arteries (*) show diffuse wall thickening and a streaky flow in the lumen. The origin of left subclavian artery (C) shows no flow.

Figure 2

Maximum intensity projection (A) and thin coronal reconstruction images (B) from two-dimensional 'time of flight' magnetic resonance angiography show no flow in the brachiocephalic artery (a) beyond the origin. The origin of left subclavian artery (b) does not show a flow signal. The left common carotid artery (c) shows a streaky flow. The image in (A) shows multiple collateral vessels (d) along with normal flow in bilateral vertebral arteries (e). Axial reconstruction image (C) shows diffuse wall thickening of arteries with luminal narrowing.