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Rana et al. Takayasu’s arteritis

brachial arteries; difference of at least 10 mmHg in
systolic blood pressure between the arms; bruit over
one or both subclavian arteries or the abdominal aorta;
arteriographic narrowing or occlusion of the entire aorta,
its primary branches, or large arteries in the proximal
upper or lower extremities, not due to arteriosclerosis,
fibromuscular dysplasia, or other causes.
The presence of three out of six criteria is required
for diagnosis and demonstrates a sensitivity of 90.5%
and a specificity of 97.8%. [16]
Ultrasound, computer tomography and magnetic
resonance angiography (MRA) have shown promise
A B in the diagnosis of TA. MRA provide high resolution

Figure 3: Magnetic resonance angiography. (A) Image of neck and detail of vessel wall thickness and lumen calcification;
thorax showing significant aorto-arteritic changes affecting all the also allow the vessel wall thickness and lumen
major vessels; (B) image of neck vessels axial section showing configuration.
significant aorto-arteritic changes affecting all the major vessels
the association with certain human leukocyte antigen Steroids are the mainstay of treatment for Takayasu’s
(alleles and other autoimmune processes such as arteritis. Steroid unresponsive patients can be treated
sarcoidosis and inflammatory bowel disease. It is also with cytotoxic drugs including cyclophosphamide,
suggested that tuberculosis may have an association, azathioprine, and methotrexate. Treatment should
given a high prevalence of active and past infection in aim to control disease activity, preserve vascular
patients with Takayasu’s arteritis. [15] competence with minimal long term side effects.
Surgical treatment is offered to those with severe
The pattern of Takayasu’s arteritis is typically triphasic, stenosis of renal artery, extremity claudication,
consisting of a systemic nonvascular phase, a vascular stenosis of three or more cerebral vessels, or evidence
inflammatory phase, and a quiescent “burnt out” of coronary artery involvement.
phase. The symptoms of Takayasu’s arteritis vary
[16]
depending on the site and degree of arterial lesions. Our patient had no past history of systemic
Most patients initially present with non-specific manifestations like fever, joint pains, and weight loss.
symptoms, such as fever, night sweats, malaise and Neurological deficit heralded the onset of disease.
arthralgia. As the disease progresses, symptoms She had five out of six of the criteria set forth by the
of end organ disease due to the ischemia, including American College of Rheumatology and was thus
renovascular hypertension or coronary artery disease, diagnosed with Takayasu’s arteritis.
may develop. As inflammation progresses, stenotic
lesions develop and patient develop associated In conclusion, when confronted with patients with
symptoms. Diminished or absent pulses, vascular neurological problems, we should be aware of rare but
bruits, hypertension, retinopathy, aortic regurgitation, possible causes, which may be treatable or at least
congestive cardiac failure, neurological manifestation positively modifiable with correct and timely diagnosis.
and pulmonary artery involvement are some of Although neurological manifestations are common in
common manifestations of these patients. patients with Takayasu’s arteritis in the chronic phase,
acute stroke as an initial presentation has rarely been
Neurological complication occurring in the chronic reported. Our patient shows that Takayasu’s arteritis
phase of the disease, range from asymptomatic should be considered in the differential diagnosis
disease to catastrophic neurological impairment and of young stroke. This case again emphasises the
most commonly include headache, dizziness, visual importance of looking for peripheral pulses and
disturbances, convulsive crisis, transient ischemic recording blood pressure in all four limbs at least in
attack, stroke and posterior reversible encephalopathy young stroke patients.
syndrome. [l7]
Financial support and sponsorship
The American College of Rheumatology established Nil.
classification criteria for the diagnosis of Takayasu’s
arteritis: age at disease onset ≤ 40 years; claudication Conflicts of interest
of the extremities; decreased pulsation of one or both There are no conflicts of interest.
194 Neuroimmunology and Neuroinflammation ¦ Volume 3 ¦ August 31, 2016