A CASE OF STROKE IN YOUNG

18 year old girl presented with complaints of inability to use left upper limb and lower limb for one day. History of deviation of angle of mouth to right side. History of headache present.No history suggestive of seizures, trauma,fever, vomiting. Her pulse rate is 80 per minute,regular in rhythm. Right carotid artery pulsation is felt feebly than the left carotid artery. Both sides posterior tibial artery and dorsalis pedis artery pulsations are felt feebly. Other peripheral pulses are normally felt.Her blood pressure examination showed right upper limb- 10678mmHg, left upper limb- 11884mmHg, , right lower limb- 12486mmHg, , left lower limb- 12686mmHg.Central nervous system examination showed UMN type of left facial nerve palsy.Motor system examination showed left hemiparesis.The patient was diagnosed as a case of stroke in young. Her investigation showed Hb-9.6gdl,ESR -54mm, CRP6, Rheumatoid factor-96, PT,aptt were with in normal limits,Lupus anti coagulant-La1La2 not significant,Canca and P-anca were negative, ANA- negative, homocysteine- 18.77mmoll.mantoux- 6mm,HIV- negative, peripheral smear examination is normal.Chest x-ray showed cardiomegaly.ECG, Echocardiography were normal.CT-brain showed right gangliocapsular infarct.Carotid vertebral Doppler study showed diffuse intimal thickening noted in the proximal part of right common carotid artery causing 96 focal stenosis with decreased flow in right internal carotid artery.64 slice CT- neck carotid angiogram showed short segment stenosis of right common carotid artery at its origin with narrowed right internal carotid artery,anterior cerebral artery,middle cerebral artery.Abdomen and lower limb CT angiogram showed occulusion of distal segments of both bilateral anterior and posterior tibial arteries. Patient was found to have stroke in young due to Takayasu arteritis. This case is presented because Our patient had no past history of systemic manifestations of takayasu disease like fever, joint pains, and weight loss. Takayasu arteritis is a large vessel vasculitis , in our patient involvement of bl anterior posterior tibial arteries (medium sized) is a relatively rare presentation.