Refractory convulsive syncope in pregnancy: a rare presentation of Takayasu’s arteritis - a case report and literature review

Abstract

Background: Neurological manifestation of Takayasu’s Arteritis (TA) in pregnancy presenting as convulsive syncope is extremely rare, and poses a serious diagnostic dilemma due to other vast causes of fits in pregnancy.
 Objective: We aimed to present and shed more light on a case of TA with convulsive syncope in pregnancy refractory to anticonvulsants for seven weeks, and review the literature on the management of TA in pregnancy.
 Case presentation: A gravida 4 para 3+0 at 28 weeks of amenorrhea presented with repeated episodes of the sudden loss of consciousness, followed by a fall and jerking of the limbs. These were refractory to anticonvulsants that she had used for seven weeks. Physical examination revealed undetectable pulse and blood pressure (BP) in the upper limbs but elevated BP in the lower limbs. Further investigations confirmed TA and she improved on steroids and antihypertensives.
 Conclusion: This case typically describes the unexpected presentation of TA with convulsive syncope. It calls for meticu- lous clinical assessment of epileptic seizures in pregnancy to avoid a late diagnosis of TA and its potential poor outcomes.
 Keywords: Takayasu’s Arteritis in pregnancy; convulsive syncope; case report.

Editorial: Infectious diseases and NCDs persist despite concerted effort

“…We bring you several papers on sexuality: a new grading system for female sexual dysfunction in Egyptian women 43 ; and one on menstrual hygiene management among adolescent school girls in Nigeria. 44 A case report on refractory convulsive syncope in pregnancy and Takayasu's arteritis 45 ends that brief section on sexuality. Some reflections on mental health include: effects of black tea consumption on depression 46 ; genetic influence of Apolipoprotein E gene ε2/ε3/ε4 isoforms on odds of mesial temporal lobe epilepsy 47 ; and correlates of substance use among undergraduates in a low income country.…”