Khealani B A, Baig S M.
Takayasu`s Arteritis presenting as Ischemic Stroke - Case Report.
J Pak Med Assoc Jan ;52(6):263-4.

We report two such cases and emphasize the need for thorough evaluation of young patients with stroke to establish the underlying etiology.

Case Report: A nineteen year old right-handed girl presented to the emergency room on 11/6/1997 with a two day history of sudden onset right-sided weakness and inability to talk. She denied any history of headaches, trauma or visual symptoms but vomited thrice on the day of presentation. There was no history of rheumatic fever or valvular heart disease. Her past history was significant for an episode of right hemiparesis, diplopia, dizziness and blurring of vision three years back. She was treated with steroids and recovered completely. Her examination revealed pallor and a left carotid bruit in addition to the neurologic deficits, which included expressive aphasia, right hemiparesis (face=arm>leg), right hyperreflexia and extensor plantar response on the right. Base line investigations revealed mild hypochromic microcytic anemia, mild neutrophil leucocytosis, normal prothrombin time, activated partial thrombin time and platelet count. Her anti-nuclear antibodies (ANA), anti- double stranded deoxy ribonucleic antibodies (anti-DNA) and anti phospolipid antibodies were negative and erythrocyte sedimentation rate (ESR), protein C, protein S and antithrombin III (AT-III) were within normal limits. Magnetic resonance imaging (MRI) of the brain showed new left basal ganglia and left parietal lobe infarctions and there was also evidence of an old pontine infarction. The echocardiogram was normal but Carotid Doppler study revealed an adherent thrombus in left common carotid artery. She was initially anticoagulated. Later a magnetic resonance angiography of the head, chest and abdomen was carried out, which showed occlusion of left common carotid and left subclavian arteries at their origins and eccentric narrowing of abdominal artery at the level of the renal artery. She was started on prednisone. Initial dose was 60 mg daily for 8 weeks and then the dose was tapered down. Currently she is taking 10 mg on every other day. She was followed up for 4 years and had not relapsed till her last visit. Her recovery, at the best, was partial.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com