Takayasu Arteritis Presenting with Massive Cerebral Ischemic Infarction with Severe Unilateral Renal Artery Stenosis: A Case Report

Abstract

Takayasu arteritis is a relatively rare type of large-vessel arteritis that primarily affects the aorta and its major branches, the coronary arteries, and the pulmonary arteries. Depending on the different groups of blood vessels involved in the disease process, the clinical presentation of Takayasu arteritis varies. Takayasu arteritis (TA) is a chronic vasculitis disease of unknown etiology. Clinically significant renal disease is relatively common, and renovascular hypertension is the major renal problem.  Here we report a case of male presenting with a debilitating massive cerebral ischemic infarct that turned out to be a relatively rare presentation of Takayasu arteritis only 5% case reported . We reported a case of 28 yr old male presented to the Emergency Department at M.B. hospital udaipur with right hemiparesis and hypertension with constitutional symptoms. On examination right hemiparesis, residual weakness left upper and lower limb and absent pulse bilateral radial, brachial and subclavian artery . laboratory results showed an elevated leucocytes counts, raised C-reactive protein and erythrocyte sedimentation rate . MRI brain with mr-angiography revealed acute with chronic cerebral ischemic infract with narrowing and occlusion of the major branches of his aortic arch with many collaterals . Contrast CT-abdomen revealed significant right renal artery stenosis . Conclusion:- Takayasu arteritis is a relatively  rare disease with various and sometimes devastating clinical manifestations, such as massive cerebral ischemic infarction as in our case. Currently, there are multiple diagnostic tools and treatment options available, and more under investigation. Early, appropriate diagnosis and initiation of proper therapy could avoid further progression and reduce complications of the disease.

Keywords: Takayasu arteritis (TA), glucocorticoid (GS), immunosuppressants (IS), methotrexate (MTX)