Atypical Takayasu Arteritis Presenting as Ischemic Stroke in a Young Female Despite Normal ESR and Preserved...

Takayasu's arteritis (TA) is a chronic granulomatous vasculitis that primarily affects young women and involves the aorta and its major branches. Although neurological manifestations, such as stroke (15.8% prevalence in TA), are uncommon, they can be debilitating. We present the case of a 30-year-old woman from Haryana, India, who presented to the hospital with acute right-sided hemiparesis and dysphasia. Despite normal inflammatory markers, neuroimaging revealed chronic infarcts accompanied by significant stenosis of the intracranial arteries and extensive collateral formation. A computed tomographic angiography (CTA) showed diffuse circumferential thickening and severe stenosis of the right internal carotid artery and its branches, indicative of large-vessel vasculitis. Notably, the involvement of the intracranial internal carotid artery represented an uncommon manifestation of TA, as the disease predominantly affects the extracranial aorta and its major branches, with intracranial arterial involvement being relatively rare. Based on clinical findings, radiological evidence, and diagnostic criteria, a diagnosis of TA was established. Based on early vascular imaging, the patient was treated with corticosteroids, methotrexate, and antiplatelet therapy, which led to significant clinical improvement. This case underscores the importance of considering vasculitic causes like TA in young stroke patients, especially when conventional risk factors are absent.