Direct involvement of intracerebral arteries in Takayasu's arteritis

A man aged 20 with sudden onset of headaches and rapidly evolving spastic quadriparesis died within 3 weeks. Pathologic examination revealed intensive inflammation confined mainly to the adventitia of the aorta, the internal carotids, and all the major intracranial arteries. The gross changes and the lymphocytic and plasma cell nature of the inflammatory infiltrates were typical of Takayasu's arteritis. Thrombosis of the right internal carotid artery resulted in ischemic necrosis of the ipsilateral hemisphere. Quite recent thrombus occluded the left internal carotid artery. This seems to be the first case report on histologically proven extensive direct involvement of intracranial vessels in Takayasu's disease. The differential diagnostic aspects of the case are also briefly discussed.