Unilateral carotid granulomatous arteritis and Crohn's disease

• Published in: Revue neurologique Vol. 166; no. 5; pp. 542 - 546
• Main Authors: Gobron, C., Kaci, R., Sokol, H., Vahedi, K., Lejoyeux, P., Guillaud, C., Wechsler, B., Gray, F., Bousser, M.-G.
• Format: Journal Article
• Language: English
• Published: Paris Elsevier Masson SAS 01.05.2010; Masson; Elsevier Masson
• Subjects: Artérite granulomateuse; Biological and medical sciences; Carotid Artery Diseases - complications; Carotid Artery Diseases - pathology; Cerebral Angiography; Cerebrovascular disease; Chemical Sciences; Crohn Disease - complications; Crohn Disease - pathology; Crohn's disease; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Functional Laterality - physiology; Granulomatous arteritis; Humans; Immunohistochemistry; Internal medicine; Magnetic Resonance Imaging; Maladie de Crohn; Male; Medical sciences; Middle Aged; Movement Disorders - etiology; Médecine interne; Neurology; Occlusion unilatérale de la carotide; Organic chemistry; Pathologie neurovasculaire; Recurrence; Stroke - complications; Stroke - pathology; Unilateral carotid occlusion; Vasculitis, Central Nervous System - complications; Vasculitis, Central Nervous System - pathology; Granulomatous arteritis; Internal medicine; Artérite granulomateuse; Unilateral carotid occlusion; Crohn's disease; Médecine interne; Pathologie neurovasculaire; Cerebrovascular disease; Maladie de Crohn; Occlusion unilatérale de la carotide; Occlusion; Nervous system diseases; Granulomatosis; Cardiovascular disease; Artery; Inflammatory disease; Arteritis; Arterial disease; Vascular disease; Crohn disease; Blood vessel; Carotid; Digestive diseases; Intestinal disease; Circulatory system
• ISSN: 0035-3787
• DOI: 10.1016/j.neurol.2009.10.005

Chronic idiopathic granulomatous arteritis of the large vessels – and, specifically, “Takayasu's arteritis” and “giant cell arteritis” – is an unusual condition that rarely leads to stroke and is only occasionally associated with Crohn's disease. We report here on a unique case of a 56-year-old man with a 25-year history of Crohn's disease who also had a 4-year history of recurrent right-sided ischaemic strokes and partial seizures, and a unilateral progressive retrograde occlusion of the right internal and common carotid arteries. Biopsies of the temporal and carotid arteries showed large-vessel granulomatous arteritis, with features of both giant cell and Takayasu's arteritis. La maladie de Takayasu et l’artérite temporale de Horton sont des causes rares d’infarctus cérébraux, exceptionnellement associées à une maladie de Crohn. Nous rapportons le tableau clinicoradiologique atypique et unique d’un homme âgé de 56 ans, suivi pour une maladie de Crohn quiescente, qui présenta 25 ans plus tard des infarctus cérébraux hémisphériques droits à répétition révélant une occlusion progressive isolée unilatérale et rétrograde sur quatre ans de l’axe carotidien droit (occlusion de branches distales de l’artère sylvienne droite puis occlusion de la carotide interne droite puis occlusion de la carotide commune droite). La preuve anatomopathologique de vascularite granulomateuse fut apportée par les biopsies temporales et carotidiennes qui objectivèrent des éléments en faveur à la fois d’une artérite gigantocellulaire de Horton et d’une artérite de Takayasu.