Takayasu Arteritis presenting with stroke: A case of lateral medullary syndrome in a 29-year-old female

Abstract

Takayasu arteritis (TA) is a chronic large vessel vasculitis that typically targets the major vessels of our body, like the aorta and its branches. Infarction of the lateral medullatermed lateral medullary syndrome, is a rare presenting feature of TA. Our report presents a 29-year-old female who was diagnosed with TA, but her presentation was a rare early manifestation of TA, presenting with lateral medullary syndrome. She came to the hospital with gradually worsening vertigo, partial ptosis, dysphagia, contralateral sensory loss, and gait instability over a period of hours. On initial physical examination, her pulse and blood pressure were missing on the left upper limb. An Imaging test, which showed significant left vertebral artery stenosis and ischemic infarction in the lateral medulla. Further tests like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were raised, while the autoimmune panel and the coagulation panel results were negative. Diagnosis of TA was made, and treatment was started for TA with steroids and methotrexate and for stroke with aspirin and atorvastatin. Treatment showed significant improvement in symptoms within the two months of strict compliance. This case emphasizes the importance of early diagnosis and thorough treatment in young TA patients who present with rare ischemic events.