Hemiballism with insular infarction as first manifestation of Takayasu's arteritis in association with chronic hepatitis B.
BACKGROUND
Takayasu's arteritis is a chronic inflammatory idiopathic disease involving large arteries like the aorta and its primary branches. Cell-mediated autoimmunity leading to vascular injury has been suspected in its pathogenesis although the antigen inducing the process remains unknown.


METHODS
A 50-year-old male patient suffered from acute hemiballism. Neuroimaging showed an infarction of right temporal insular cortex. Neurosonology and MR-Angiography revealed bilateral long-distant subtotal stenosis of the common carotid artery and left-sided occlusion of the subclavian artery. Positive hepatitis B serology with active viral replication was found. In the absence of other vasculitis or inflammation markers, Takayasu's arteritis was diagnosed and steroid therapy was started.


CONCLUSIONS
Unilateral insular lesions may lead to transient hemiballistic movements which could be the result of decreased inhibitory output of the insula to basal ganglia. The hepatitis B virus possibly contains a surface antigen inducing a specific cellular immune response leading to Takayasu's arteritis.
Etgen
Thorleif
T
Department of Neurology, Technical University of Munich, Möhlstrasse 28, 81675 München, Germany. etgen@neuro.med.tu-muenchen.de
Winbeck
Kerstin
K
Conrad
Bastian
B
Sander
Dirk
D
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000473:pathology; D016893:Carotid Stenosis / Q000473:pathology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D020820:Dyskinesias / Q000000981:diagnostic imaging / Q000209:etiology*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013256:Steroids; D013349:Subclavian Steal Syndrome / Q000473:pathology; D013625:Takayasu Arteritis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D018616:Ultrasonography, Doppler, Duplex
D000893:Anti-Inflammatory Agents; D013256:Steroids