Intracranial and Extracranial Neurovascular Manifestations of Takayasu Arteritis

AJNR Am J Neuroradiol. 2017 Apr;38(4):766-772. doi: 10.3174/ajnr.A5095. Epub 2017 Feb 23.

Abstract

Background and purpose: Takayasu arteritis is a rare, large-vessel vasculitis that presents with symptoms related to end-organ ischemia. While the extracranial neurovascular manifestations of Takayasu arteritis are well-established, little is known regarding the intracranial manifestations. In this study, we characterize the intracranial and cervical neurovascular radiologic findings in patients with Takayasu arteritis.

Materials and methods: Patients with Takayasu arteritis who presented to our institution between 2001 and 2016 with intracranial and/or cervical vascular imaging were included in this study. Images were evaluated for the presence of vascular abnormalities, including intracranial or extracranial stenosis, vessel-wall thickening, dissection, subclavian steal, aneurysms, infarcts, and hemorrhages. Descriptive analyses are reported.

Results: Seventy-nine patients with Takayasu arteritis met the criteria for inclusion in this study. The most common presenting neurologic symptoms were headache (32.9%) and dizziness (15.2%). Intracranial and extracranial vascular imaging was performed in 84.8% and 89.9% of patients, respectively. Among patients with intracranial vascular imaging, 3 (3.9%) had intracranial aneurysms, 3 (3.9%) had acute large-vessel occlusion, 6 (7.6%) had intracranial vasculitis, and 1 (1.3%) had reversible cerebrovascular constriction syndrome. Among patients with cervical vascular imaging, 42 (53.1%) had some degree of narrowing of the common carotid artery and 18 (22.8%) had narrowing of the ICAs. Seventeen patients (23.6%) had subclavian steal.

Conclusions: Intracranial vascular abnormalities in patients with Takayasu arteritis presenting with neurologic symptoms are not rare, with cerebral vasculitis seen in 7.8% of patients, and stroke secondary to large-vessel occlusion, in 3.9% of patients. Cervical vascular manifestations of Takayasu arteritis were present in most patients in our study.

MeSH terms

  • Adult
  • Blood Vessels / pathology*
  • Carotid Stenosis / diagnostic imaging
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Infarction / diagnostic imaging
  • Constriction, Pathologic
  • Dizziness / etiology
  • Female
  • Headache / etiology
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Nervous System / pathology*
  • Subclavian Steal Syndrome / diagnostic imaging
  • Takayasu Arteritis / complications*
  • Takayasu Arteritis / pathology
  • Vasculitis, Central Nervous System / diagnostic imaging
  • Young Adult