A Case Report of Takayasu's Arteritis With Cerebral Infarction As Initial Presentation

Abstract

Takayasu's arteritis is a chronic inflammation of the large arteries such as the aorta and its primary branches, causing progressive arterial occlusion. This leads to reduced blood flow in the limbs and organs, resulting in arm or leg claudication, diminished or absent peripheral pulses, and end-organ ischemia. Stroke is one of the common complications; however, it is rarely the initial presentation. We describe one such case of a 16-year-old female, who presented with right-sided hemiparesis and non-fluent aphasia, without any significant past history. On examination, her right arm was cold and pulseless. She was extensively investigated for the cause of her presentation. Only non-specific inflammatory markers such as erythrocyte sedimentation rate (ESR) were elevated. Imaging studies revealed left middle cerebral artery territory infarct with occlusion of common carotid arteries, bilateral bifurcation, most parts of the left internal carotid artery, and the proximal part of the right internal carotid artery. She was diagnosed with Takayasu's arteritis and was prescribed steroids, on which she gradually recovered and was discharged. In conclusion, young patients, who present with stroke, should be investigated for Takayasu's arteritis, which leads to earlier treatment and prevention of further life-threatening end-organ damage.

Keywords: : aortitis; large vessel vasculitis; pulseless disease; takayasu arteritits; young onset stroke.

Figure 1. (A) NCCT brain showing left-sided cortical hypodensity (arrow) corresponding to acute infarct. (B) DW-MRI of the brain showing diffusion restriction (hyperintensity) in the left cerebral cortex (arrow) and left gangliocapsular region suggestive of acute non-hemorrhagic infarct.

R- Right, L- Left, NCCT- Non-contrast computed tomography, DW-MRI: Diffusion weighted-magnetic resonance imaging

Figure 2. Magnetic resonance angiography (MRA) showing (A) occlusion of the right common carotid artery (red arrow) and left internal carotid artery (yellow arrow), and (B) occlusion of the left middle cerebral artery (MCA) and A1 segment of the left anterior cerebral artery (ACA). A normally enhancing right MCA (yellow arrow) and A1 segment of the right ACA (red arrow) are shown for comparison.

R - Right, L - Left