Takayasu Arteritis with Neurological Manifestations: Clinical and Neurovascular Imaging Characteristics

Abstract

Background: Takayasu arteritis (TA) is a large vessel vasculitis that may be accompanied by neurologi cal involvement in 57%-80% of the patients. The aim of this work is to describe the clinical and neuro vascular imaging abnormalities in TA patients with neurological manifestations.

Methods: Thirty-nine TA patients with neurological manifestations and available brain magnetic reso nance imaging (MRI), MR angiography (MRA), and MR venography of the intracranial and cervical vessels were studied. Patients with thrombophilia or hyperlipidemia were excluded.

Results: The mean age at TA diagnosis was 30.56 ± 8.74 years, and 33 (84.62%) of the patients were women. The most frequent neurological manifestations included headaches (64.1%), syncope (12.8%), and visual loss (10.26%). According to the angiographic classification, 37 (94.9%) of the patients had involvement of branches from the aortic arch (Type I), and only 2 (5.1%) had diffuse aortic involve ment (Type V). Steno-occlusive lesions of the medium-sized intracranial arteries were observed in 11 (28.21%) of the patients. Features suggestive of small vessel disease were found among 16 (41%); 13 had abnormal MRI findings and 3 other patients had normal MRI and increased collateral circulation on MRA without associated intracranial arterial stenosis. Opening of the collateral circulation was seen in 14 (35.9%) patients. Venous involvement (affecting the cerebral venous sinuses and jugular veins) was found in 12 (30.77%) patients.

Conclusion: Patients with TA and neurological manifestations exhibit a spectrum of extracranial and intracranial vascular abnormalities including large, medium, and small blood vessels, as well as the cerebral venous sinuses and jugular veins.

Cite this article as: Shahin AA, Zayed HS, Fathi S, Elsaid NY. Takayasu arteritis with neurological manifestations: clinical and neurovascular imaging characteristics. Eur J Rheumatol. 2025, 12(4), 0003, doi:10.5152/eurjrheum.2025.25003.