Internuclear Ophthalmoplegia in Pontomesencephalic Stroke as the First Manifestation of Takayasu Arteritis

Abstract

Takayasu arteritis (TA) is a chronic inflammatory disease affecting the aorta and its main branches. Patients generally present with symptoms such as fever, myalgia, limb claudication, carotid vessel tenderness, hypertension, and asymmetric pulses. Neurological manifestations are present in a small percentage of patients, with stroke occurring in about 10% of cases. Stroke, occurring as the very first presentation of the disease, is however unusual. We present an atypical case of unilateral internuclear ophthalmoplegia (INO) due to acute pontomesencephalic stroke in the absence of cerebral angiographic abnormality, in a 36-year-old woman as the initial presenting feature of TA. The patient had angiographic evidence of bilateral subclavian artery stenosis but no abnormality in the cerebral vessels, thus pointing toward a possible embolic origin from inflamed vessels. Though other unusual neurological manifestations have been reported, INO as the first manifestation has not been found in medical literature so far.