NEUROIMAGES Perfusion alterna in Takayasu arteritis Figure CT perfusion map revealing alternating hyper- and hypoperfusion FLAIR sequences reveal right cerebral (A) and left occipital (D) swelling with midline shift. CT perfusion map shows right cerebral hyperperfusion and left frontal hypoperfusion (B). Axial DWI 3 weeks later shows left frontal cerebral infarction (C). The MRA (same day as A) demonstrates absent left internal carotid arterial flow due to proximal stenosis (E, arrows). A 48-year-old woman with Takayasu arteritis had a worsening headache and left limb weakness. Blood pressure measured 150/75 mm Hg from the right arm. Brain MRI showed right cerebral and bioccipital swelling ( figure, A, D). The MRA revealed proximal left common carotid artery and ipsilateral internal carotid artery stenosis ( figure, E) and the CT perfusion map revealed alternating hyperperfusion on the right hemisphere and hypoperfusion on the left ( figure, B). Controlled blood pressure lowering over the next several days resulted in complete recovery. Two weeks later following an emergent abdominal surgery that was complicated by transient hypotension to 100/65 mm Hg, she developed expressive aphasia with right hemiparesis ( figure, C). Left carotid stenosis protected from effects of high systolic pressure, yet predisposed to an ischemic stroke from blood pressure lowering. Gregory Youngnam Chang, MD, FAAN, Orange, CA Disclosure: The author reports no disclosures. Address correspondence and reprint requests to Dr. Gregory Youngnam Chang, Department. of Neurology, Bldg. 55, Rm. 121, 101 The City Drive, South, Orange, CA 92868; gychang@uci.edu 614 Copyright © 2008 by AAN Enterprises, Inc. Perfusion alterna in Takayasu arteritis Gregory Youngnam Chang Neurology 2008;71;614 DOI 10.1212/01.wnl.0000323933.15055.0c This information is current as of August 18, 2008 Updated Information & Services including high resolution figures, can be found at: http://www.neurology.org/content/71/8/614.full.html Citations This article has been cited by 1 HighWire-hosted articles: http://www.neurology.org/content/71/8/614.full.html##otherarticles Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): All Cerebrovascular disease/Stroke http://www.neurology.org//cgi/collection/all_cerebrovascular_disease_ stroke Critical care http://www.neurology.org//cgi/collection/critical_care MRI http://www.neurology.org//cgi/collection/mri Stroke in young adults http://www.neurology.org//cgi/collection/stroke_in_young_adults Stroke prevention http://www.neurology.org//cgi/collection/stroke_prevention Permissions & Licensing Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/misc/about.xhtml#permissions Reprints Information about ordering reprints can be found online: http://www.neurology.org/misc/addir.xhtml#reprintsus Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright . All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.