Takayasu’s Arteritis: A Case Report and Review of Literature

Abstract

Takayasu’s arteritis is a rare type of idiopathic, medium and large vessel vasculitis involving aorta and its main branches. There were several clinical presentations, depending on the vessel involved. The author reports a case of 35-year-old woman presenting with subacute headache, vomiting and coexisting focal neurological symptoms including speech difficulty and weakness of right side arm and leg one day before arrival. The initial physical examination revealed the present of systolic bruit over the left supraclavicular area. The decrease of pulsation of left radial artery and blood pressure of left brachial artery were detected (128/81 mmHg in the right arm and 92/72 mmHg in the left arm). The neurological examination revealed motor aphasia and right hemiparesis. National Institute of Health Stroke Score was 9/42. Computed tomographic of the brain showed hypodensity lesion in the left frontoparietal white matter. Initially, she was treated with the standard acute stroke medication with antiplatelet and HMG CoA reductase inhibitor. During the admission, she developed an episode of transient loss of vision of her left eye, and then fully recover within thirty minutes. The laboratory examinations showed an elevated C-reactive protein and normal erythrocyte sedimentation rate. The subsequent magnetic resonance angiography of brain demonstrated severe narrowing of the left proximal internal carotid artery, and left brachiocephalic artery and evidence of left subclavian steal phenomenon. Multi-foci of luminal narrowing involving medium-sizes intracranial vessels were also observed. Then, she was diagnosed as Takayasu’s arteritis.