Recurrent Vertigo: Is it Takayasu's Arteritis?

Takayasu's arteritis (TA) is a chronic, idiopathic, inflammatory disease, that is more common in females and Asian countries. A 38-year-old female presented with recurrent vertigo. Detailed examination revealed discrepancies in peripheral pulses and raised blood pressure in bilateral lower limbs. Possibility of vasculitis involving arch of aorta or its branches was kept. Investigations were suggestive of Takayasu's arteritis, and noncontrast tomographic scanning (NCCT) of head showed B/L parietal infarcts. The disease is itself uncommon, and the presentation with vertigo only is rare. In this case vertigo may be due to Takayasu's arteritis itself or due to bilateral parietal infarcts. 1. Introduction Takayasu's arteritis, formerly known as “pulseless disease,” is a chronic idiopathic inflammatory disease which affects the vessels in the body. First described in the 1800s, this rare condition is more commonly found in women in their 40s and more common in Asian countries. The aorta and its main branches are the primary vessels involved, with the most common features reflected as ischemia or aneurysm formation. The diffuse nature of this vasculitis can involve multiple organ systems to varying degrees and can present with a wide range of symptoms [1]. With Takayasu's arteritis being a rare condition and its acute phase presentation often mimicking to other conditions, diagnosis is often difficult. Diagnosis is usually guided by ACR criteria [2]. 2. Case Report A 38-year-old female presented to emergency department with the complaint of vertigo for last 3 days (only while standing and walking) and loose stools for one day, along with the complaint of similar episodes of vertigo for last 3 months which were associated with episodes of fall at times (but no loss of consciousness). On examination radial pulses were not palpable and brachial pulses were very feeble in bilateral upper limbs with no audible bruit over carotids. Detailed examination revealed palpable popliteal and dorsalis pedis arteries bilaterally in lower limbs. Her BP was recorded 194/102？mm, Hg (right lower limb), and 192/106？mm, Hg (left lower limb); examination of other systems was within normal limits except fundus examination which was suggestive of hypertensive changes. Possibility of vasculitis involving aorta and its branches was kept and investigations were sent. Routine investigations were within normal limits. Lipid profile, 2D echo, was normal. Anti-nuclear antibody, anti-cardiolipin antibody, anti-phospholipid antibody, anti-beta-2-glycoprotein antibody, and lupus anti-coagulant