Takayasu's disease: Ultrasonic evaluation of extracranial and intracranial hemodynamics

In Takayasu's disease, inflammatory vessel wall changes occur in the large extracranial arteries and may consequently influence cerebral hemodynamics. This study describes the extra- and intracranial hemodynamic states in three young patients, aged 32, 29, and 22 years, without permanent neurological deficit. Extracranial vessels were investigated primarily by duplex scanner and intracranial vessels by three-dimensional transcranial Doppler before and after intravenous administration of 1 g acetazolamide. The ultrasonic findings were confirmed by aortocervical angiography. Two patients were treated by corticosteroids. In spite of extracranial vessel narrowing, all three patients had normal MCA velocities in the resting condition. Impaired vasomotor reactivity was found in the middle cerebral artery corresponding to the high degree stenosis of the brachiocephalic trunk in one patient and in the anterior and posterior cerebral arteries unilaterally in two patients and bilaterally in one. Decrease in the pulsatility index after acetazolamide administration probably depends on the vasodilation and decrease in peripheral resistance. Extra- and intracranial Doppler ultrasound is valuable to follow the progress of arteritis and to adjust treatment.