Nonpulsatile cerebral perfusion in Takayasu's arteritis.

A nonpulsatile cerebral perfusion may be encountered in an artificial cardiopulmonary bypass used in cardiac surgery, which is exceptional in physiological conditions. The authors report on a 37-year-old woman with Takayasu's arteritis (TA) who had been suffering from progressive visual loss and recurrent seizures. Ocular findings of chronic ischemia and multiple, subcortical, high-signal lesions in magnetic resonance (MR) imaging were indicative of significant hemodynamic impairment. MR angiography showed the complete occlusion of the innominate artery, the left common carotid artery (CCA), and the subclavian artery from the orifice of the aortic arch. The patient's transcranial Doppler (TCD) waveform was flat throughout all segments of the intracranial arteries. Intravenous acetazolamide injection confirmed the severe impairment of vasoreactivity. After a bypass graft from the aorta to the left CCA, flow velocity and pulsatility were dramatically increased without postoperative complications. A nonpulsatile cerebral perfusion indicates severe hemodynamic impairment and is partially reversible by a surgical bypass graft. TCD seems to be useful to detect "high-risk" patients and to follow up in TA.