Hafize YALINIZ, M. Şah TOPÇUOĞLU, Acar TOKCAN, Yakup SARICA, Hacer BOZDEMİR

Serebral dolaşımın sadece sağ vertebral arterle sağlandığı bir Takayasu arteritisi

Sol fronto orbital başağrısı ve aynı tarafta görme bozukluğu, solda kuvvet kaybı şikayeti ile başvuran 42 yaşında kadın hastanın şikayetleri altı ay önce başlamış. Arkus aortografide her iki a.karotis komminus ve subklavian arterler ile sol vertebral arterde total oklüzyon tespit edildi. Abdominal aortografi de renal arter distalinde diffüz darlık görüldü. Kraniyal kanlanmanın sadece sağ vertebral arterle sağlanmasına rağmen orta ve anterior serebral arter kanlamaları spin-ECHO ve PC-MR ile normal sınırlarda bulundu. Sol gözde florescain anjiografisi ile vaskulit tespit bulundu. Ciltte immun histokimyasal inceleme ile damar duvarlarında immun kompleks birikimi tespit edildi. Bu bulgularla Takayasu hastalığı teşhisi konulan hastada serebral akımın sadece sağ vertebral arter ile sağlanmasına rağmen ciddi fakat nörolojik bulgu olmayışı dikkat çekici olarak değerlendirildi.

A cerebral circulation supplied by only the right vertebral artery (Takayasu's arteritis)

Fortytwo-year-old woman suffered from left fronto-orbital aching and amaurosis. The arcus aortography revealed total occlusion of both common carotid and subclavian arteries and left vertebral artery. The right vertebral artery was spared. The abdominal aortography showed serious narrowing of the abdominal aorta below the renal artery level. Despite the fact that only right vertebral artery was patent. Blood flow of the middle and anterior cerebral arteries were found in normal range by "spin-ECHO" and PC; MR studies. The fluorescain angiography of left eye showed vasculitis. Immune histochemical studies of the skin displayed immun compleks accumulation on the vessel walls. With these finding the diagnosis of Takayasu's disease was made. Total dependence of the cerebral arterial circulation on the right vertebral artery is the hallmark of this very rare case of Takayasu's disease.

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1. Giardino JM, Hoffman G5, Leavitt RY. Takaya- su’s disease; nonspecific aortoarteritis. In Rut- herford RB Eds. Vascular Surgery 4 th Ed. Phila- delphia; WB founders Comp. p. 245-253, 1995.
2. Wilke WS. Large vessel vssculitis (giant cell ar- teritis, Takayasu arteritis). Baillieres Clin Rheu- matt›11997; 11: 2, 285-313.
3. Türkoglu C, Memiş A, Payzin S,Akm M, et al. Takayasu arteritis in Turkey Int J Cardiol 1997; 54 suppl: S l3S-136.
4. Pokrnvsky AV. Morıspecific aortoarteritis. In Rutherford RB Eds. Vascular Surgery 3 th Ed. Philadelphia, WB Saunders Comp. p. 217-237, ş9gg
5. Ltipi-Herrara E, Sanchez-Torres G. Morcushomer J, et a1. Takayaqu arteritis. Clinical Study of 107 cases. Am Heart J 1997; 93: 94-107.
6. lshikawa K. Survival and morbdity after diagno- sis of occlusive thrombo aorttopathy. (Takaya- en’s disease) Am J Cardiol 198Ij O: 1026-1032.
7. lehikawa K. Natural history and clasification of occlusivete thrombo aortopathy (Takayasu’s disease). Circulation 1978; 57j 27-35.
8. Cottrell ED, Smith LL. Management of uncom- mtm lesions affecting the extracranial vesseb (Takayasu’s arteritis); in Rutherford RB Eds. Vasculary surgery 4 th ed. Philadelphia. WB Saunderes Comp. p. 1628-1631, 1995.
9. Ishikawa K. Diagnoetik approach and prososed criteria for the clinical diagnosis of Takaysu‘s ar- ieriopathy. J Am Coll Cardiol J988; 12: 964•972.
10. Hata A, Moda M, Moriwaki R. Numano F. Angi- ographic findings takayasu arteritis: new claSSi- fication. Int J Cardiol 1997; 54 Suppl: S lS5-63.
Lande A. Abdominal Takayasu’s aortifis, the middle aortic syndrome and artherosclerosis. A critical review (editodral). Int Angiol 1998; 17: i, 1-9.
t2. Nakabayashi K, Kurata N, Nangi M, ct al. Pul- monary artery involvement as first manitéstati- on'in three cases of takayasu arteritis. Int J Cardi- ol 1997; 54 Suppl: S 177-183.
13. Hara M, Soube R, Ohba S, Kitase M, et a1. mffu- se pulmonary lesions in early phase Takayasu arteritis predominantly involving pulmonary artery. Comput Asist Tomgr 1998; 225: 801-803.
14. Schmidt MH, Fox AJ, NicoIIe DA. Bilateral ante- rior ischemic optic neuropathy as a presentation Takayasu’s disease. J Neurmiphthalmol 1997; 17: 3, 156-61.
15. Elevard DS, Duprez DA, De Buysere ML, et a1. Totally dependence of the cerebral circulation on the right vertebral artery in Takayasu's dise- ase-A case report. Int ] Angiology 1994; 3: 61-64.
16. Dabrowski GP, Akers DE }r. Takayasu’s arteriñs managemenel of a complex case and lftarature review. J La State Med Soc 1997: 149: 6, 250-2S3.
17. Fields WS. Aortocranial occlusive vascular disea- se (Stroke). Clinical symposia (CIBA) V: 26, Nr: 4, 1974.
18. Hall S, Barr W, Lie ET, et al. Takayasu’s arteritis. A. study of 32 North American patients. Medici- ne 198G; 64: 89.
Ishikawa K., Yonekwa Y. Regresion of Carotid st enosis after corticosteroid therapy in exclusive thromabourtapathy (Takayasu’s disease). Stroke 1987; 18: 677
20. Shelhamet SH, Volkman DS, Parillo Je, et al. Taknyasu’s arterilis and it’s therapy. Ann int Med 1985, 103: 12.
21. Kimoto S, The history and present status of aortic surgery in Japan. Particulary for aortitis syndrome. J Cardiovasc Surg 1979j 20: 107-J26.
Wear Fa, Yellin AE, Ciimpen DH. Surgical pro- cedures in the management of Takayasu’s arteri- tis. J Vase Surg J990; 12: 429.