Takayasu’s arteritis with arteriographic evidence of intracranial vessel involvement

Takayasu’s arteritis (TA) is an idiopathic granulomatous vasculitis that affects the aorta and its main branches.1 Approximately 10 to 15% of patients with TA will have ischemic stroke or transient ischemic attacks.2,3⇓ These strokes have mainly been attributed to stenotic extracranial vessels. At least one case report has described intracranial arteritis in a patient with TA discovered at autopsy.4 We report two cases of TA with clinical and arteriographic involvement of the intracranial arteries. ### Case 1. A 32-year-old woman sought treatment for left forearm pain and cyanosis of the fingertips associated with use and absent left radial pulse. The left subclavian and axillary arteries were completely occluded with abundant collaterals as demonstrated by angiogram. Erythrocyte sedimentation rate (ESR) was 108. The findings were consistent with TA, and the patient was prescribed prednisone, followed 3 months later with methotrexate. Seven months after initial diagnosis of TA, the patient sought treatment for abdominal pain, severe frontal headache, and transient right leg heaviness. An initial …