2602 Takayasu Arteritis: an unusual cause of stroke in a young patient with no risk factors

BackgroundTakayasu arteritis is a rare cause of young stroke due to large-vessel vasculitis primarily affecting the aorta and its primary branches. Women are affected in 80 to 90 percent of the time.Case-ReportA 34 yr old female presented with sudden onset of slurred speech and confusion. Her husband had to repeat his questions and instructions many times before eliciting a response. There were no other neurological signs and symptoms. She was not on drugs or alcohol.Physical ExaminationShe had global aphasia with a right upper motor neuron facial palsy and right hemiparesis.InvestigationsMRI brain revealed a left middle cerebral artery territory (MCA) infarct. On MRA there was diffuse narrowing of the left internal carotid artery compared to the right side.CT 4 vessel angiogram revealed smooth mural thickening with perivascular haziness along the aortic arch, brachiocephalic trunk, proximal right subclavian and right common carotid arteries. There was severe stenosis of the left subclavian artery origin with occlusion of the entire left common carotid artery.MRI vessel wall imaging revealed circumferential wall thickening and intense enhancement in the left common carotid artery from its origin. There was similar involvement of the left subclavian artery origin.DiagnosisTakayasu arteritis.DiscussionTakayasu arteritis is an inflammatory vasculitis and is a rare cause of stroke. Steroids are the mainstay of treatment and in the long run, steroid sparing agents are used.ConclusionClinicians should not forget Takayasu arteritis in young/middle-aged stroke patients, especially when vascular risk factors are absent.