Cerebral Infarction as the Initial Presentation of Takayasu Arteritis in a Young Indian Female: An Unusual Case Report

Background:: Takayasu's arteritis (TA) is an uncommon, chronic vasculitis that mostly involves the aorta and its principal branches, leading to stenosis, occlusion, or aneurysmal dilation. Although TA typically presents with constitutional and vascular symptoms, ischemic stroke as an initial manifestation is uncommon. Case Presentation:: Here, we report a case of a 30-year-old female with right-sided hemiparesis and right-sided facial paralysis. On admission, neurological examination revealed a motor power grade of 0/5 in the right upper and lower limbs, with an extensor plantar response. Blood pressure measurements demonstrated significant interlimb discrepancies: right arm 80/50 mmHg, left arm 70/50 mmHg, whereas lower limb readings were markedly elevated (right leg 180/70 mmHg, left leg 170/80 mmHg). Imaging revealed intracranial arterial thrombosis and extensive large-vessel stenosis causing an acute ischemic stroke. Laboratory workup showed elevated inflammatory markers, and further diagnostic evaluation confirmed TA according to the 2022 ACR/EULAR classification criteria. Notably, the patient reported excessive coffee consumption (15-20 cups daily), which may have contributed to sympathetic overactivity and vascular dysregulation. The patient received pulse corticosteroids and azathioprine, resulting in substantial neurological improvement. At discharge (two weeks after admission), motor power had increased to 3/5 in the right arm and 4/5 in the right leg, and on a six-month follow-up visit, she demonstrated notable neurological improvement, with muscle strength assessed as 4/5 in the right upper limb and 5/5 in the right lower limb. During regular outpatient follow-up (December 9, 2025), lower limb strength was fully restored, and upper limb power had also improved to near-normal levels. Conclusion:: This case underscores the need for early recognition of TA in young stroke patients, particularly in endemic regions, to prevent long-term vascular complications.