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Takayasu arteritis presenting as embolic stroke.

Kristina Field1, Laila Gharzai1, Kaye Bardeloza1

  • 1Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.

BMJ Case Reports
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This case highlights that patients with Takayasu arteritis may experience recurrent embolic strokes. Early screening for stroke sources is crucial, especially when symptoms reappear.

Keywords:
strokevasculitis

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Area of Science:

  • Vascular Neurology
  • Rheumatology
  • Cardiovascular Imaging

Background:

  • Takayasu arteritis is a rare, chronic inflammatory disease affecting large arteries, primarily the aorta and its branches.
  • Ischaemic stroke can be a presenting or a complication of Takayasu arteritis, often due to large artery stenosis or occlusion.
  • Tissue plasminogen activator is a critical treatment for acute ischaemic stroke, but secondary prevention strategies are vital.

Observation:

  • A 52-year-old woman presented with acute ischaemic stroke symptoms, successfully treated with tissue plasminogen activator.
  • Initial work-up revealed an aortic infiltrate consistent with early Takayasu arteritis.
  • The patient experienced recurrent stroke symptoms shortly after discharge, with newly identified intraluminal carotid artery clots.

Findings:

  • The recurrent ischaemic stroke was attributed to previously undetected intraluminal clots in the left common carotid and left internal carotid arteries.
  • Despite initial treatment for stroke and diagnosis of Takayasu arteritis, embolic events recurred rapidly.
  • This suggests that standard stroke work-up may miss embolic sources in the context of active vasculitis.

Implications:

  • Patients diagnosed with Takayasu arteritis require vigilant monitoring for embolic stroke, even after initial treatment.
  • Comprehensive screening for embolic sources, including intraluminal thrombi, is essential in Takayasu arteritis patients presenting with recurrent ischaemic events.
  • This case underscores the importance of considering vasculitis as a potential cause of embolic stroke and the need for tailored diagnostic and therapeutic approaches.