Title: Takayasu Arteritis and PRES Syndrome - A Rare Case Series
Authors: Dr Ritu Gupta, Dr Sandeep Singh, Dr Tarunendra Kumar Mishra, Dr Ishan Verma
DOI: http://dx.doi.org/10.18535/jmscr/v4i1.12
PRES is a very rare manifestation of Takayasu’s arteritis. It can present with headache, seizures, altered sensorium with visual disturbances. Two young teenager patients presented in ward with complaints of severe headache, Hypertention , vomiting ,blurring of vision followed by GTCS and altered sensorium for about one month.(1) Their routine investigations like CBC,LFT,RFT appears to be normal with raised ESR.CE-MRI of brain shows focal areas of hyperintensity scattered in white matter signs of PRES.CT angiography of abdominal aorta showed possibility of autoimmune vasculitis with bilateral proximal renal artery stenosis ,critical stenosis on right with small right kidney and decreased enhancement. Patients were put on antihypertensive and antiepileptic medication along with steroids to manage Takayasu’s Arteritis with PRES. These patient’s respond’s symptomatically and were referred to higher centre for recanalisation of renal artery stenosis. Keywords - PRES-Posterior reversible encephalopathy syndrome, TA-Takayasu Arteritis, GTCS- Generalised Tonic Clonic seizures, CBC- Complete blood count, LFT- Liver fumction test, RFT-Renal function test. 1. Arend WP, Michel BA, Bloch DA, et al : The American College Of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33:1129,1990. 2. Mason JC: Takayasu arteritis –Advances in diagnosis and management.Nat Rev Rheumatol 6:406,2010 3. Fuchs M, Briel M, Daikeler T et al:The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging 39:344,2012. 4. Kulkarni TP, D'Cruz IA, Gandhi MJ, Dadhich DS. Reversal of renovascular hypertension caused by nonspecific aortitis after corticosteroid therapy. Br Heart J. 1974; 36: 114–116. 5. Ishikawa K, Yonekawa Y. Regression of carotid stenoses after corticosteroid therapy in occlusive thromboaortopathy (Takayasu’s disease). Stroke. 1987; 18: 677–679. 6. Ito I. Medical treatment of Takayasu arteritis. Heart Vessels Suppl. 1992; 7:133–137. 7. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopahy syndrome.NEJM.1996;334. 8. Bartynski WS.Posterior reversible enceph-alopathy syndrome,part 1:fundamental imaging and clinical features. AJNR Am J Neuroradiol.2008;29:1036-1042 9. Fugate Je,Claassen DO,CloftHJ,et al.Posterior reversible encephalopathy syndrome: associated clinical and radiological findings.MayoClin Proc. 2010;85:427. 10. Bartynski WS.Posterior reversible encephalopathy syndrome,part 2 : controversies surrounding pathoph-ysiology of vasogenic edema.AJNR Am J Neuroradiol.2008;29:1043-1049.Abstract
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