Journal of Neurology

, Volume 250, Issue 2, pp 226–229

Hemiballism with insular infarction as first manifestation of Takayasu's arteritis in association with chronic hepatitis B

  • Thorleif Etgen
  • Kerstin Winbeck
  • Bastian Conrad
  • Dirk Sander
ORIGINAL COMMUNICATION

DOI: 10.1007/s00415-003-0984-5

Cite this article as:
Etgen, T., Winbeck, K., Conrad, B. et al. J Neurol (2003) 250: 226. doi:10.1007/s00415-003-0984-5

Abstract.

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. Case report: 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.

Key words hemiballism insular infarction Takayasu's arteritis hepatitis 

Copyright information

© Steinkopff Verlag 2003

Authors and Affiliations

  • Thorleif Etgen
    • 1
  • Kerstin Winbeck
    • 1
  • Bastian Conrad
    • 1
  • Dirk Sander
    • 1
  1. 1.Department of Neurology, Technical University of Munich, Möhlstrasse 28, 81675 München, Germany. etgen@neuro.med.tu-muenchen.deDE

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