Takayasu arteritis in a patient presenting with stroke and improvement of hemiparesis following vascular bypass surgery: A case report

Abstract

Takayasu arteritis (TA) is a rare disease, with an estimated incidence in general population of <1/year/million, and its presentation as a stroke is an even less common occurrence. The case presented herein is unusual for the fact that the surgical procedure was performed on an urgent basis, irrespective of the active or inactive status of the disease; the bypass technique involved multiple sites; the patient was administered an original combination of medications before and after the procedure, and the patient exhibited significant neurological improvement after the subacute period of the stroke (6 weeks after stroke, 1 week after the procedure), which was sustained at the 18-month follow-up. Published literature on bypass surgery for TA indicate that the majority of complications (aneurysms, stenosis, intracerebral hemorrhage, etc.) occur during the early stages and affect approximately one-third of patients; this procedure was also successful as the patient subsequently began recovering motor function, indicating the successful, sustained re-vascularization of the affected motor areas. Being able to restore the patient's independent activities of daily living is an important goal, which was achieved in this patient and may serve as a reference point for what is possible to achieve in these cases.

Arterite de Takayasu: A Apresentação Atípica de uma Doença Rara

“…Os critérios diagnósticos para AT, publicados pela American College of Rheumatology em 1990, têm uma sensibilidade de 91% e especificidade de 95%, e sugerem a presença de pelo menos 3 dos seguintes elementos: i) idade <40 anos; ii) claudicação das extremidades; iii) diminuição dos pulsos braquiais; iv) diferenças de >10 mmHg na pressão arterial sistólica entre os membros superiores; v) sopro na subclávia ou aorta; e vi) alterações angiográficas da aorta e dos seus ramos principais. 10,11 No caso do nosso doente, à data do diagnóstico, cumpria 4 dos 6 critérios.…”

“…Contudo, sabe-se que, somando ao risco cardiovascular, os doentes com AT apresentam um perfil lipídico mais aterogénico quando comparados com uma população sem esta patologia. 10,15 CONTRIBUIÇÃO AUTORAL/ AUTHORS CONTRIBUTION CF, CM, AO, AB e CO: Execução e revisão do caso clínico CF, CM, AO, AB and CO: Execution and review of the clinical case…”