Concurrent Takayasu Arteritis With Common Variable Immunodeficiency and Moyamoya Disease

Skeik, Nedaa; Rumery, Kyle K.; Udayakumar, Prabhu D.; Crandall, B; Warrington, Kenneth J.; Sullivan, Timothy M.

doi:10.1016/j.avsg.2012.09.003

Cited by 24 publications

(15 citation statements)

References 17 publications

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“…One patient with intracranial vasculitis in our series also had idiopathic carotid terminus occlusions, which had a similar appearance to Moyamoya disease. This has also been reported in prior case reports, 16,17 and the exact prevalence of this finding and the pathophysiology in patients with TA are still unknown. Unlike those with typical Moyamoya disease, however, this patient initially presented with a basilar artery occlusion (Fig 2).…”

Section: Discussionsupporting

confidence: 53%

Intracranial and Extracranial Neurovascular Manifestations of Takayasu Arteritis

Bond

Nasr²,

Lehman³

et al. 2017

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Takayasu arteritis is a rare, large-vessel vasculitis that presents with symptoms related to end-organ ischemia. While the extracranial neurovascular manifestations of Takayasu arteritis are well-established, little is known regarding the intracranial manifestations. In this study, we characterize the intracranial and cervical neurovascular radiologic findings in patients with Takayasu arteritis.

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Section: Discussionsupporting

confidence: 53%

Intracranial and Extracranial Neurovascular Manifestations of Takayasu Arteritis

Bond

Nasr²,

Lehman³

et al. 2017

AJNR Am J Neuroradiol

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“…[48][49][50][51][52] These could be designated moyamoya type 1 (Asian genotype) and moyamoya type 2 (white genotype and other genetic syndromes). Furthermore, autoimmune disorders 30,[53][54][55][56][57][58][59] and atherosclerosis/vasculitis [60][61][62][63][64][65][66] have been associated with the moyamoya phenotype and could be designated moyamoya type 3 and 4, respectively. Figure 3 shows select examples.…”

Section: Proposed Classification Systemmentioning

confidence: 99%

Surgical Outcomes and Predictors of Stroke in a North American White and African American Moyamoya Population

et al. 2013

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Outcomes were favorable with revascularization in this subset with moyamoya. A significant association between a history of thyroid disease and recurrent stroke was found. Additionally, high prevalences of autoimmune disease, hypertension, and thyroid disease were found in our cohort, suggesting that they may play a role in the pathophysiology and progression of moyamoya disease in this population. A new classification for moyamoya is proposed based on these data.

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“…Takayasu arteritis is an uncommonly rare, chronic large vessel vasculitis with poorly understood pathogenesis and etiology. 1,2 Women are 8.5 times more likely to be affected than men, with a typical onset between 10 and 40 years of age. 2,3 Despite a worldwide distribution, the disease is most common in Asian populations; Japan has an estimated 150 new cases per year, compared with 1 to 3 new cases per year per million people in the United States and Europe.…”

Section: Discussionmentioning

confidence: 99%

“…21 There is new evidence indicating that rituximab, a B cell targeting medication might be helpful in patients with refractory Takayasu arteritis. 1,22 Our patient's diagnosis of Takayasu arteritis was based on the presentation of indicative clinical symptoms, along with CT and MR angiography revealing stenosis, wall thickening, and ultimately dilation of parts of the aortic branch. Successful resolution of symptoms and normalization of ESR levels on prednisone validated the presence of inflammation accompanying this disease.…”

Section: Discussionmentioning

confidence: 99%

Rare Case of Takayasu Arteritis with Concurrent Aneurysmal Dilation and Stenosis

2015

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A 30-year-old woman from Japan with a history of hypothyroidism and chronic intermittent right side throbbing headache presented with a 3-month history of intermittent right side neck pain that was aggravated with neck movement and associated with mild blurry vision. Vital signs revealed a blood pressure of 106/78 mm Hg in bilateral upper extremities, a heart rate of 72 beats/min, and a normal temperature. Physical examination displayed normal findings aside from a low-pitched bruit in the right side neck. Laboratory findings revealed a normal complete blood count and an unremarkable basic metabolic profile. Magnetic resonance (MR) angiogram of the neck and brain revealed aneurysmal dilation of the right innominate and proximal right common carotid arteries associated with circumferential wall thickening of the right common carotid artery. It also revealed a 75% focal stenosis by NASCET criteria in the right common carotid artery distal to the aneurysmal dilatation (►Fig. 1a, b).To further explore, MR aortogram with T2-weighted images (VIBE technique) were negative for aortic wall thickening, stenosis, dilatation, or involvement of the visceral vessels. It redemonstrated the aneurysmal dilatation of the right innominate artery with a maximum diameter measuring 2.0 cm as well as aneurysmal dilatation and stenosis of the right common carotid artery.Further laboratory work up revealed an elevated erythrocyte sedimentation rate (ESR) of 48 mm/h with a normal C-reactive protein (CRP) level of 0.8 mg/dL.On the basis of her gender, place of origin, age, clinical presentation, laboratory, and imaging findings, the diagnosis of Takayasu arteritis was made. As her symptoms were mild and inflammatory markers were not significantly elevated, management was started with prednisone 20 mg and aspirin 81 mg daily. The patient's symptoms improved over the next month and repeat laboratory work displayed normalized ESR (18 mm/h) and CRP (0.7 mg/dL) levels. Repeat MR aortogram revealed persistent right innominate and right common Keywords ► Takayasu arteritis ► vasculitis ► stenosis ► aneurysm AbstractTakayasu arteritis is a rare, chronic large vessel vasculitis that primarily affects women aged 10 to 40 years of Asian descent. The inflammatory processes of the disease can result in stenosis and/or occlusion of the aorta and its branches, causing a wide range of symptoms. Rarely, damage of the elastic lamina or muscular media can cause aneurysmal dilation of the affected vessel. Diagnosis is based on the clinical presentation, laboratory proof of inflammation, and imaging finding of wall thickening in the acute phase and later arterial stenosis or occlusion. Management includes disease control with immunosuppression and some patients might require revascularization. Here, we present a rare case of Takayasu arteritis with both right common carotid artery aneurysmal dilation and stenosis at a conforming site. Although aneurysmal dilation has been sparsely reported in the Takayasu arteritis literature, our case may represent the disti...

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Concurrent Takayasu Arteritis With Common Variable Immunodeficiency and Moyamoya Disease

Cited by 24 publications

References 17 publications

Intracranial and Extracranial Neurovascular Manifestations of Takayasu Arteritis

Intracranial and Extracranial Neurovascular Manifestations of Takayasu Arteritis

Surgical Outcomes and Predictors of Stroke in a North American White and African American Moyamoya Population

Rare Case of Takayasu Arteritis with Concurrent Aneurysmal Dilation and Stenosis

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