Takayasu's arteritis (TA) is a chronic inflammatory vascular disease that mainly affects large vessels. Central nervous system involvement occurs in about 20% of cases with rare involvement of intracranial vessel, and its typical manifestation is cerebral ischemia or stroke. Reversible cerebral vasoconstriction syndrome (RCVS) is a group of disorders with prolonged, but reversible vasoconstriction of the cerebral arteries with acute-onset, severe, recurrent headaches with or without neurologic signs or symptoms. We report a case of TA in a 17-year old girl who presented with secondary RCVS. She complained of thunderclap headache, seizure and acute stroke. 3-dimensional computed tomography scan and magnetic resonance angiography of head revealed irregular thickening of aortic wall and its main branches with multifocal narrowing of intracranial basilar artery, which improved after oral nimodipine intake. This case highlights RCVS as an unusual manifestation of TA and demonstrates the diagnosis, treatment and response to therapy of RCVS in TA, which resolved after treatment with calcium channel blocker.
Basilar Artery ; Brain Ischemia ; Calcium Channels ; Central Nervous System ; Cerebral Arteries ; Glycosaminoglycans ; Head ; Headache ; Headache Disorders, Primary ; Humans ; Magnetic Resonance Angiography ; Neurologic Manifestations ; Nimodipine ; Seizures ; Stroke ; Takayasu Arteritis ; Vascular Diseases ; Vasoconstriction

A 61-year-old woman came to the hospital with dyspnea and pleural effusion on chest radiography. She underwent repeated thoracentesis, transbronchial lung biopsy, bronchoalveolar lavage, and thoracoscopic pleural biopsy with talc pleurodesis, but diagnosis of her was uncertain. Positron emission tomography showed multiple lymphadenopathies, so she underwent endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymph nodes. Here, we report a case of malignant pleural mesothelioma that was eventually diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. This is an unusual and first case in Korea.
Biopsy ; Bronchoalveolar Lavage ; Bronchoscopy ; Dyspnea ; Female ; Humans ; Korea ; Lung ; Lymph Nodes ; Mesothelioma ; Needles ; Pleural Effusion ; Pleurodesis ; Porphyrins ; Positron-Emission Tomography ; Talc ; Thorax