Takayasu Arteritis Presenting with Internal Carotid Artery Dissection

Geraldes, Ruth; Batista, P. P.; Pedro, Luís Mendes; Fernandes, Andreia; Melo, Teresa Pinho e

doi:10.1159/000336243

Cited by 10 publications

(4 citation statements)

References 19 publications

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“…Takayasu arteritis commonly involves subclavian arteries and common carotid arteries, and the involved common carotid artery shows prominent long‐segment homogeneous circumferential intima‐media thickening (usually 2.5–5.0 mm) with relative sparing of the carotid bulb and internal carotid artery in the early or active phase on sonography 1 . Wall thickening of the involved arteries decreases in the chronic phase (usually 1.1–2.0 mm), 1 and substantial arterial stenosis, occlusion, and dissection can develop 2 , 3 . Intimal denudation and an intimal flap in the common carotid artery are unusual pathologic characteristics of Takayasu arteritis and have been rarely reported.…”

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confidence: 99%

Chronic Takayasu Arteritis With a Multifocal Intimal Defect and an Intimal Flap in the Common Carotid Artery

Yang

Park

2013

J of Ultrasound Medicine

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Takayasu arteritis commonly involves subclavian arteries and common carotid arteries, and the involved common carotid artery shows prominent long-segment homogeneous circumferential intima-media thickening (usually 2.5-5.0 mm) with relative sparing of the carotid bulb and internal carotid artery in the early or active phase on sonography. 1 Wall thickening of the involved arteries decreases in the chronic phase (usually 1.1-2.0 mm), 1 and substantial arterial stenosis, occlusion, and dissection can develop. 2,3 Intimal denudation and an intimal flap in the common carotid artery are unusual pathologic characteristics of Takayasu arteritis and have been rarely reported. Here we describe multifocal intimal denudation and an intimal flap in the common carotid artery in a patient with Takayasu arteritis.A 39-year-old woman was transferred to our hospital for a persistent pulsatile headache and suspected bruits over both carotid arteries and the left subclavian artery. In the outpatient neurology clinic, bilateral carotid and left subclavian artery bruits and high blood pressure (170/100

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confidence: 99%

Chronic Takayasu Arteritis With a Multifocal Intimal Defect and an Intimal Flap in the Common Carotid Artery

Yang

Park

2013

J of Ultrasound Medicine

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“…Takayasu arteritis was diagnosed and steroids were started. Prosthetic replacement of the right common carotid artery was also performed [15]. …”

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confidence: 99%

Complete ophthalmoplegia, complete ptosis and dilated pupil due to internal carotid artery dissection: as the first manifestation of Takayasu arteritis

Herath

Pahalagamage

Withana

et al. 2017

BMC Cardiovasc Disord

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BackgroundTakayasu arteritis is a rare, chronic large vessel vasculitis involving the aorta and its primary branches. As the disease progresses, the active inflammation of large vessels leads to dilation, narrowing and occlusion of the arteries. Arterial dissection is due to separation of the layers of the arterial wall resulting in a false lumen, where blood seeps into the vessel wall. Neurological sequelae of intracranial arterial dissection results from cerebral ischemia due to thromboembolism and hypo perfusion. Internal carotid artery dissection in Takayasu arteritis is very rare and complete ophthalmoplegia due to internal carotid artery dissection is also rare. This is the first case report of Takayasu arteritis presenting as complete ophthalmoplegia due to internal carotid artery dissection.Case presentationA 38-year-old Sri Lankan female presented with sudden onset severe headache, fixed dilated pupil, complete ptosis and ophthalmoplegia on the right side. On imaging, dissection and dilatation was evident in the right internal carotid artery from the origin up to the cavernous segment. She also had stenosis and aneurysmal dilatation of right subclavian artery. Takayasu arteritis was diagnosed subsequently. She was started on aspirin and high dose steroids.ConclusionsInternal carotid artery dissection within the cavernous sinus can lead to third, fourth and sixth nerve palsy due to compression, stretching and ischemia from occlusion of the nutritional arteries. This case report illustrates that internal carotid artery dissection should be a differential diagnosis in palsies of the third, fourth, or sixth cranial nerves, especially when associated with headache. In cases of internal carotid artery dissection, vasculitis such as Takayasu arteritis should also be considered.

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“…9 In rare cases, aneurysmal lesions can rupture or dissect, necessitating the need for urgent surgical intervention. 29,30 One must carefully weigh the decision to operate on patients with Takayasu arteritis because of the inherent inflammatory properties of the disease, with complications such as hemorrhage, valve and suture line detachment, pseudoaneurysm formation, and paravalvular leakage. 30 We did not consider any surgical or endovascular intervention for our patient as she is completely asymptomatic.…”

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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Takayasu Arteritis Presenting with Internal Carotid Artery Dissection

Cited by 10 publications

References 19 publications

Chronic Takayasu Arteritis With a Multifocal Intimal Defect and an Intimal Flap in the Common Carotid Artery

Chronic Takayasu Arteritis With a Multifocal Intimal Defect and an Intimal Flap in the Common Carotid Artery

Complete ophthalmoplegia, complete ptosis and dilated pupil due to internal carotid artery dissection: as the first manifestation of Takayasu arteritis

Rare Case of Takayasu Arteritis with Concurrent Aneurysmal Dilation and Stenosis

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