Takayasu Arteritis Mistaken for Epilepsy: A Case Presenting With Convulsive Syncope

Abstract

Takayasu arteritis (TA) is a chronic inflammatory disease characterized by granulomatous vasculitis that predominantly manifests as panaortitis. This occlusive thromboaortopathy lacks pathognomonic features often resulting in a diagnostic dilemma leading to its underrecognition, misdiagnosis and delayed management. Although neurological manifestations are not uncommon in TA, convulsive syncope as an initial clinical presentation is extremely rare. We report a case of convulsive syncope as a manifesting symptom of TA. A 17-year-old male patient of African origin was referred to us from an upcountry regional hospital with a diagnosis of medically intractable epilepsy for cardiovascular review. He presented with a 28-week history of generalized tonic-clonic seizures followed by loss of consciousness. He denied history of recurrent headaches, fever, visual disturbances, arthralgias, claudication or unintentional weight loss. Physical examination revealed feeble left-sided brachial and radial pulses, elevated blood pressure, differences in blood pressure between arms and leftsided carotid and vertebral bruits. Computed tomography angiogram of his thoracic and abdominal aorta revealed changes suggestive of a diffuse arteritis. Additionally, magnetic resonance angiogram of the brain revealed total occlusion of the left common carotid, left internal carotid, left external carotid and left vertebral arteries. Based on the physical examination and radiological findings, we reached a diagnosis of TA. He was prescribed dexamethasone, methotrexate, acetylsalicylic acid and amlodipine. He had a remarkable recovery and was seizure-free for the last 5 months after discharge. TA may manifest with convulsive syncope mimicking epilepsy. Despite its rarity, presentations of this nature continue to challenge clinicians resulting in delayed diagnosis with irreversible life-threatening consequences to patients. In view of this, physicians should strive to take detailed history and perform thorough physical examination so as to timely pick the characteristic signs of TA especially in patients presenting with unanticipated symptoms.

Case report: Aggressive progression of acute heart failure due to juvenile tuberculosis-associated Takayasu arteritis with aortic stenosis and thrombosis

“…Seizures may be caused by stroke, hypertensive encephalopathy, posterior reversible encephalopathy syndrome (PRES), and other reasons. Neurological symptoms in TA are usually associated with decreased blood flow due to steno-occlusive lesions and/or shifting of the blood flow (steal) ( 17 , 18 ). PRES is extremely rare in TA.…”

Ischemic stroke at first presentation of Takayasu arteritis in a young African male from Kenya, East Africa: Case report and brief literature review.

“…(14,15) The cases in literature describing patients from East Africa show a mixed pattern at initial presentation with diffuse aortic and retinal involvement respectively in two cases in Tanzania. (16,17) Elsewhere in Uganda, a case report describes autopsy findings of fibrosis in several branches of the arch of aorta. (18) In Kenya, two cases have been reported, one presenting as chronic headache with carotid artery stenosis and thoracic aorta involvement with another describing femoral involvement from biopsy of amputated limb in a set up with limited angiography capabilities at the time.…”