Cerebral hemorrhagic infarction following diffuse cerebral arteriopathy in a child with Takayasu's arteritis: A case report

Abstract

Takayasu arteritis (TA) is a chronic inflammatory arteriopathy of unknown origin characterized by granulomatous vasculitis of medium and large arteries. Extracranial artery involvement causes stroke in 8 to 35% of patients with TA. Cerebral artery involvement in TA is extremely rare. A 3-year-old boy with juvenile idiopathic arthritis suffered from generalized convulsions. Computed tomography (CT) revealed cerebral hemorrhage and subarachnoid hemorrhage in the left temporal lobe. Cerebral angiography showed irregular dilatation and narrowing of the cerebral arteries in the left hemisphere and cerebellar arteries in the left cerebellar hemisphere. CT aortography demonstrated dilatation of the aortic arch and its main branches, thick vessel walls and renal artery stenosis which caused sustained high blood pressure and increased serum rennin. We diagnosed TA and hemorrhagic infarction of the left temporal lobe. No surgical evacuation of cerebral hemorrhage was required. Perifocal edema was treated with osmotic agents. We increased the dose of steroid and administered methotrexate for the TA. This treatment resulted in clinical remission of the inflammation, and the patient was discharged with minimum neurological deficit. Cerebral arteriopathy due to Takayasu's arteritis is rare. However, we should consider TA in the differential diagnosis of children presenting with stroke attack. Both early diagnosis and appropriate treatment may prevent deterioration of the chronic inflammation and improve the outcome.