Seizures and lost pulses: an atypical case of Takayasu’s arteritis

Abstract

Seizure is a rare neurological manifestation of Takayasu's arteritis (TA). This report is about a 15 year old female patient, admitted with loss of consciousness, generalised seizures and hypertension. The patient had asymmetric peripheral pulses and unequal blood pressure in the arms. Doppler study showed diminished blood flow predominantly in left upper limb, while fluorescent aortogram revealed left subclavian artery stenosis. MRI was suggestive of posterior reversible encephalopathy syndrome (PRES). Electroencephalogram (EEG) report was consistent with cerebral dysrhythmia. The patient had coexistent ostium secundum atrial septal defect. Previous case reports attribute seizures to ischemia (caused by involvement of the carotid and vertebral arteries) and PRES in patients of TA. The presence of cerebral dysrhythmia after clinical improvement made the cause of seizure difficult to ascertain in our patient. The presence of atrial septal defect (ASD) was possibly coincidental.