A Silent Vasculitis With a Loud Presentation: Takayasu Arteritis Causing Intracerebral Hemorrhage

Takayasu arteritis is a chronic large-vessel vasculitis affecting the aorta and its major branches, most commonly in young women. Neurological involvement is well recognized but typically manifests as ischemic stroke due to arterial stenosis or occlusion. Intracerebral hemorrhage as the initial presentation of Takayasu arteritis is rare and is usually related to severe secondary hypertension or extensive vascular disease. We describe a 27-year-old woman who presented with acute left-sided hemiplegia and facial asymmetry and was found to have a right gangliocapsular intracerebral hemorrhage. She had a background of poorly controlled hypertension and chronic kidney disease without a prior diagnosis of vasculitis. Clinical examination revealed multiple peripheral vascular bruits, prompting further evaluation. CT pan-aortography demonstrated multiple saccular aneurysms involving the infrarenal abdominal aorta and bilateral common iliac arteries, consistent with Numano type IV Takayasu arteritis. The patient underwent surgical intervention followed by immunosuppressive therapy, with stable neurological and clinical status at the three-month follow-up. This highlights the importance of a careful bedside examination during patient examination in order to potentially save a patient's life from an underlying illness.