Malignant hemispheric infarction in Takayasu arteritis

Abstract

JO N 2932 rial embolism and aneurysm formation may occur [6]. Devastating stroke as one of the initial manifestations of TA is rare [5]. We report the case of a young woman with extensive anterior and middle cerebral artery infarction, subsequent malignant edema and life-saving hemicraniectomy. The 17-year-old woman was admitted to our hospital with acute right-sided hemiparesis, head and gaze deviation to the left and global aphasia. Arterial pulses were not palpable on the left arm. In the three and a half weeks prior to admission she had experienced repeated incomplete loss of vision in the left eye lasting for one to five minutes. An ophthalmological examination two weeks prior to admission had shown no abnormalities. The patient has lived in Germany throughout her life. Her mother is German; her father was born in Afghanistan. She had always been healthy and on no regular medication. Vascular risk factors including smoking, recreational drug use, migraine and oral contraceptive use were absent. Neuroradiological imaging (computed tomography (CT), CT angiography, magnetic resonance imaging (MRI) and MR angiography) revealed extensive left anterior and middle cerebral artery infarction, proximal occlusion of the left common carotid artery (CCA), concentric stenosis of the right CCA and proximal occlusion of the left vertebral artery (Fig. 1 A, B). In addition to the multiple vessel occlusions, Duplex sonography revealed concentric long-segment homogenous wall-thickening of the right CCA leading to stenosis with a markedly increased flow velocity of 265/85 cm/s, typical for Takayasu arteritis (Fig. 1 C) [6]. The erythrocyte sedimentation rate (ESR) on admission was moderately elevated to 33 mm in the first hour. Other Thomas Pfefferkorn H. Bitterling K. Hufner C. Opherk S. Schewe H. W. Pfister A. Straube M. Dichgans