Dear Editor,
We read the article “Takayasu's Arteritis in a Libyan Female” in the esteemed “Ibnosina
Journal of Medicine and Biomedical Sciences” with great interest. El-Shareif reported
the case of an elderly female who presented with low potassium levels and hypertension.
An abdominal ultrasound showed renal size asymmetry. A magnetic resonance angiography
revealed a thick abdominal aortic artery wall; the left renal artery and left common
iliac artery were occluded, and the right common iliac artery and both subclavian
arteries had significant stenosis. A diagnosis of Takayasu's arteritis (TA) was made.
In this way, this case was important because TA is a disease common in east Asians,
but only rarely encountered in Arab populations.[[1]]
TA is vasculitis of large vessels as well as giant cell arteritis, which is characterized
by granulomatous inflammation that most commonly affects women of childbearing age
from Asian countries. In this context, neurological manifestation can occur due to
stenosis or occlusions of the central nervous system vasculature.[[2]]
Here, we would like to highlight some important topics about the neurologic manifestations
that together with the article of El-Shareif lead to a better comprehension of TA.
First, the occurrence of stroke during the lifetime of a patient with TA is of >15%,
which is at least 50% more than that of a normal person.[[3]] A recent retrospective, multicentric study that aimed to evaluate the impact of
stroke on prognosis in TA patients found interesting results. At the end of the follow-up,
more than half of the individuals had a neurological impairment, about 30% had recurrence
of stroke, and one-in-five individuals suffered from epilepsy.[[2]]
The neurological manifestation in TA such as visual impairment, dizziness, stroke,
or even transient ischemic attack probably results from the decrease of blood flow
secondary to stenosis/occlusion lesions, thromboembolism, or hypertension. Kim et
al. correlated TA's neurological clinical findings with cerebral angiographic features.
Their study revealed that the main cause of neurological manifestation in TA is due
to stealing syndrome which shifts the blood flow. Moreover, they stated that hemodynamic
assessment is useful as a method to predict the occurrence of severe neurological
complications in patients that need active interventions.[[4]]
The first manifestation of stroke as the first manifestation of TA was already reported
in literature. Sikaroodi et al. concluded in one of their cases that due to the low
incidence of the disease and presentation, the diagnosis and treatment were delayed.[[5]] It is worthy of mentioning that as in giant cell arteritis, the maintenance of
treatment by patients with TA is important because alterations in medication doses
could lead to severe complications.[[6]]
Authors' contributions
JPR carried out the literature search, review, and manuscript preparation. ALFC performed
the manuscript editing, collected the clinical data, review.
Editors:
Elmahdi Elkhammas
