A 42-year-old gentleman, left-handed, a gardener by profession, presented with complaints of vertiginous sensations associated with prolonged usage of his left upper limbs. These resolved with rest. There was no history of neck pain, radiation, claudication, tinnitus, decreased hearing, diplopia, dysarthria, dysphagia, or weakness. Non-contrast computed tomography of the head was within normal limits. 2D-echocardiography and Electrocardiogram (ECG) were normal. The Computed Tomography (CT) angiography of his brain and neck [Figure 1] showed features suggestive of Takayasu arteritis. He was started on prednisolone and methotrexate with symptomatic relief.
Figure 1.
CT angiography of the brain and neck showing non-opacification of the left CCA from its origin with intraluminal thrombus and long-segment stenosis (50–60%) of the left ICA distal to the carotid bulb till the terminal ICA. Approximately, 50% stenosis of the right subclavian artery origin from the brachiocephalic trunk. Short-segment non-opacification with an intraluminal thrombus of the left subclavian artery distal to its origin proximal to the vertebral artery origin
Takayasu arteritis is a large-vessel vasculitis affecting the aorta and its branches.[1] The subclavian steal syndrome occurs due to the reversal of flow in the vertebral artery toward the subclavian artery (during periods of increased demand) because of stenosis/occlusion of the proximal subclavian artery.[2] It manifests with transient ischemic episodes of the posterior cerebral circulation.[2] The disease usually responds to corticosteroids and surgical treatment and is indicated when medical therapy does not yield a symptomatic response.[3]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Ishikawa K. Diagnostic approach and proposed criteria for clinical diagnosis of Takayasu's arteriopathy. J Am Coll Cardiol. 1988;12:964–72. doi: 10.1016/0735-1097(88)90462-7. [DOI] [PubMed] [Google Scholar]
- 2.Yoneda S, Nukada T, Tada K, Imaizumi M, Takano T, Abe H. Subclavian steal in Takayasu arteritis: A hemodynamic study by means of ultrasonic doppler flowmetry. Stroke. 1997;8:264–8. doi: 10.1161/01.str.8.2.264. [DOI] [PubMed] [Google Scholar]
- 3.Moncada G, Kobayashi Y, Koneko E, Nishiwaki Y, Kishi Y, Numano F. Subclavian steal syndrome secondary to Takayasu arteritis. Int J Cardiol. 1998;66(Suppl 1):S231–6. doi: 10.1016/s0167-5273(98)00173-9. [DOI] [PubMed] [Google Scholar]