Takayasu Arteritis Presenting With Hypotension and Chronic Cerebral Infarctions in a Young Woman: A Case Report

Takayasu arteritis (TAK) is a rare large-vessel vasculitis that predominantly affects young women and can present with nonspecific symptoms, making early diagnosis challenging. Neurological manifestations may occur secondary to involvement of the carotid and vertebral arteries and can result in cerebral ischemia. We report the case of a 28-year-old woman who presented with recurrent dizziness, presyncope, palpitations, visual disturbances, and persistent hypotension. Initial neuroimaging demonstrated indeterminate supratentorial hypodensities, while subsequent magnetic resonance imaging of the brain revealed multiple chronic cerebral infarcts involving the bilateral centrum semiovale and an abnormal flow void of the right internal carotid artery. Further computed tomography angiography demonstrated extensive large-vessel disease, including marked narrowing and wall thickening of the bilateral common carotid and subclavian arteries, critical stenosis of the right internal carotid artery, and narrowing of both vertebral arteries. Clinical examination revealed absent peripheral pulses and carotid and subclavian bruits, raising suspicion for large-vessel vasculitis. Following multidisciplinary assessment, the combination of the patient's age, chronic cerebral ischemic changes, extensive arterial disease, pulse deficits, and vascular bruits was considered consistent with TAK. She was treated with intravenous methylprednisolone followed by oral prednisolone and aspirin, with significant improvement in her presenting symptoms. This case highlights the importance of considering TAK in young patients presenting with unexplained neurological symptoms, hypotension, or chronic cerebral ischemic lesions, particularly when vascular examination reveals pulse deficits or arterial bruits. It also emphasizes the value of comprehensive vascular imaging and multidisciplinary assessment in identifying extensive large-vessel involvement.