Cerebrovascular findings in Takayasu disease

The authors define the frequency, nature, and extent of cerebrovascular seq uelae of Takayasu arteritis using functional imaging. Retrospective analysi s of the cases derived from the Durban Stroke Data Bank (n = 1100) and Durb an Metropolitan Vascular Surgery Database (n = 5300) consisted of evaluatio n by contemporary neuroimaging modalities including single positron emissio n computed tomograpy (SPECT), magnetic resonance imaging (MRI) diffusion sc anning, and transcranial Doppler (TCD). Of all the patients identified with Takayasu disease (n = 142), 29 (20%) patients were identified with a prima rily cerebrovascular presentation. The recent advent of modern functional i maging techniques allowed only the 10 most recent patients with a cerebrova scular presentation to be evaluated. Of these 10, 8 (80%) had normal neurol ogic deficit scores (Canadian neurologic score) and 9 (90%) were not disabl ed as determined by handicap scores (Rankin). The anatomic brain scans (9 M RI, 1 CT) were normal in 5 patients (50%). In 7 patients, transcranial Dopp ler sonography revealed increased velocities mainly in the anterior circula tion with turbulence that was not circumscribed. Single positron emission c omputed tomograpy scanning revealed areas of hypoperfusion, mostly multiple , in all of the 7 cases investigated. The cerebral perfusion index was dete rmined in 7 patients, with a good prognosis in 2 patients and a moderate pr ognosis in 5. Cerebral effects of Takayasu disease are best monitored by a combination of clinical and functional imaging such as TCD and SPECT scanni ng.