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Next, I'd like to talk about

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two inflammatory conditions.

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The first is Takayasu's Arteritis.

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It's seen in young women,

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particularly Asian females under 30.

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It's an idiopathic inflammatory disease

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involving the aortic arch and branches.

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Patients present with neck pain.

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and strokes.

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They usually have constitutional syndromes such

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as fatigue, malaise, and fever, and the patients

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have smooth concentric wall thickening of their

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proximal, carotid, and vertebral arteries, and

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not infrequently have occlusion in strokes.

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Here's an example.

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These are images of a 19-year-old female who

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had right facial droop and hemiplegia, and you

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can see a pointed, occluded appearance of the

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left common and right common carotid arteries.

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And on the left, she threw an embolus

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to her left MCA, seen here on this MIP.

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And she had a left MCA stroke

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involving the left lentiform nucleus.

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On the axial images, you can see non

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opacification of the internal carotid arteries.

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They're not opacified.

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Um, there's obviously normal pacification of

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the jugular veins and of the vertebral arteries.

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And this is another case of Takayasu's,

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and you can see basically all the major,

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um, vessels from the arch, the proximal

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subclavian artery, the parietal artery,

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brachycephalic artery, the common carotid artery

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are all occluded and there are collaterals.

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which basically supply

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the vessels more distally.

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Here's the MRA and you can see

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the left vertebral artery and the

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right vertebral artery are patent.

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The bilateral internal carotid arteries are

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patent and the circle of Willis looks normal.

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And again, all the major vessels

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coming off the arch are occluded and

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there's a network of collaterals.

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collateralization, she only has these tiny.

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intracranial strokes that you

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can see on this flare image.

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This is a vessel wall imaging where you have

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smooth enhancement in the vessel wall, um, which

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is typically seen with inflammatory diseases.

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And then carotidynia or TIPIC syndrome,

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which stands for transient perivascular

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inflammation of the carotid artery,

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is another inflammatory condition.

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The patients present with unilateral

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neck pain near the carotid bulb.

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They frequently have a history of migraines.

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They'll have elevated inflammatory

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markers, such as a sed rate and CRP.

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And on imaging, what you see is eccentric

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thickening of the carotid wall and

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the perivascular tissues and stools.

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fat stranding.

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Resolves with nonsteroidals and steroids.

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So this is a patient who had neck pain and you

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can see there's abnormality in the carotid bulb.

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It should be filled out, but

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there's a convexity there.

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And when you look at the axial images,

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you can see this inflammatory tissue

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along the posterior wall of the.

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Proximal internal carotid artery

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and also there's fat stranding.

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Um, on the right you can see all this normal fat

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around the vessels, but on the left there's this

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fat stranding and you can see it as you go up.

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Uh, one more cut, more superiorly again,

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stranding surrounding the proximal internal

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carotid artery that you don't see on the right.

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So that's TIPIC syndrome.