Takayasu Disease with Absence of Major Intracranial Arteries: A Case with Minimum Symptoms
Journal Title: Nepal Journal of Neuroscience - Year 2013, Vol 10, Issue 2
Abstract
Takayasu Disease (TD) is a relatively uncommon chronic and progressive vasculopathy. Aorta and its major branch involvement is typical feature of this disease. Absence of major braches of arch of aorta is not that common and is a fatal condition. We present a 58-year-old female with absent bilateral carotid arteries and right vertebral artery (VA) with only left VA preserved with minimal symptoms. She had giddiness and mild headache with past history of hypertension since several months back. On examination she had mild weakness of left upper limb and could walk normally without support. Magnetic resonance image (MRI) revealed right frontal water shed infarction. Her carotid doppler study showed bilateral carotid stenosis which was confirmed by CT angiography (CTA). Conventional cerebral angiography showed absent brachiocephalic artery (BA) and its branches and absent left CCA. Subclavian artery was very tortuous with a prominent left vertebral artery (VA) arising from it. Left VA supplied bilateral anterior and posterior circulation through a prominent right posterior communicating artery (P Com A) and intact anterior communicating artery (A Com A). Bilateral normal anterior, middle and posterior cerebral artery (ACA, MCA and PCA) and their distal branches were well visualized. The lady had only one, i.e. left VA, out of six major vessels, namely right external carotid (ECA), right internal carotid (ICA), right VA, left ECA, left ICA and left VA, of head. The patient is stable with just antiplatelet therapy.
Authors and Affiliations
Dr Prabin Shrestha, MD, PhD
Keywords
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