Ischemic Stroke as the Initial Manifestation of Takayasu Arteritis in a Pediatric Patient

Abstract

We describe the clinical presentation of a 16-year-old female patient who presented with an acute ischemic stroke as the initial manifestation of Takayasu arteritis (TA). The patient was admitted with a sudden neurological deficit characterized by right hemiparesis and expressive aphasia. This symptom is extremely rare as the primary presentation of the disease. Imaging studies using CT angiography and panangio-MRI revealed a subacute infarction in the territory of the left middle cerebral artery and right posterior cerebral artery, associated with concentric parietal thickening of the supra-aortic trunks and the aorta in multiple segments (ascending, transverse, and isthmus), superior mesenteric artery, and left external iliac artery, consistent with type V+P TA. Physical examination revealed weak pulses and a blood pressure differential >10 mmHg between the upper and lower extremities. Immunosuppressive therapy was initiated with methylprednisolone, cyclophosphamide, methotrexate, and systemic anticoagulation. The patient showed progressive improvement in muscle strength, although ophthalmological sequelae persisted. This case underscores that stroke can be the initial clinical manifestation of AT in adolescents, highlighting the importance of assessing pulses and blood pressure in all four limbs in cases of unexplained neurological symptoms.