2966 A rare case of acute ischemic stroke due to takayasu arteritis with concurrent ankylosing spondylitis

BackgroundTakayasu arteritis (TA) is a large-vessel vasculitis affecting the aorta and its primary branches. Ankylosing spondylitis (AS) is a spondyloarthritis causing chronic inflammation of the spine and sacroiliac joints. We present a rare case of acute ischemic stroke from newly diagnosed TA and pre-existing AS.Case ReportA 45 yr-old man with a 6-yr history of AS (HLA B27 positive) on methotrexate and sulfasalazine presented with light-headedness and transient blurred vision on right gaze. There were no other neurological symptoms and no family history of AS or TA.Neurological examination was normal with no deficits. BP (right arm) 97/53 mm Hg, (left arm) 134/94 mm Hg. The right radial pulse amplitude was reduced. Heart and lungs were normal.InvestigationsMRI brain revealed acute left posterior cerebral artery territory infarcts. The right vertebral artery (VA) was non-dominant. There was no flow limiting stenosis of the vertebral or basilar arteries.CT aortogram revealed bilateral subclavian artery stenosis with wall thickening (right more severe than left) suggestive of TA.Left VA flow was antegrade on carotid ultrasound.Transthoracic echocardiogram was normal. ESR 33 mm/hr.DiagnosisAcute ischemic stroke secondary to newly diagnosed TA with pre-existing AS.DiscussionThere are few published case reports of concurrent TA and AS. Both are inflammatory diseases of imperfectly elucidated pathophysiology. Autoimmune mechanisms and genetic polymorphism may be involved. Further study of the relationship between both diseases is required. Treatment: steroids and immunosuppression.ConclusionTA and AS are rare disease which may present as acute ischemic stroke.