A case of takayasu arteritis presenting with multiple cerebral infarcts: Diagnostic and therapeutic challenges

Takayasu arteritis (TA) is a rare chronic granulomatous vasculitis affecting the aorta and its major branches, with neurological complications such as multiple cerebral infarcts being unusual but potentially disabling. We describe the case of a 49-year-old male c hronic smoker who presented with acute lower-limb paralysis. Initial evaluation resulted in misdiagnosis, delaying definitive management. Neuroimaging revealed infarcts in the distal anterior cerebral artery and left posterior cerebral artery territories, while digital subtraction angiography demonstrated critical occlusions and stenoses of the carotid and vertebral arteries, confirming TA. The patient received corticosteroids, anticoagulants, and intensive physiotherapy, leading to significant neurological recovery. Thus, we show the importance of maintaining a high index of suspicion for TA in middle-aged patients with unexplained multiple cerebral infarcts and absent peripheral pulses. Early vascular imaging, prompt initiation of immunosuppressive therapy, and a multidisciplinary treatment approach are essential to improve outcomes and reduce long-term disability in such rare but high-risk presentations.