Takayasu aortoarteritis (TA) rarely affects the nervous system, but when it does, it usually manifests as
cerebral ischemia or
stroke. These
strokes have mainly been attributed to stenotic extracranial vessels.
Stenoses of intracranial vessels, although rare in TA, can occur due to either embolization into the vessel or because of the vasculitic process itself.
Intracranial aneurysms are very rare in patients with TA. Bilateral cavernous internal carotid artery (ICA)
aneurysms are rarer. They have been reported following
radiation therapy and in association with
fibromuscular dysplasia and
juvenile Paget disease. Bilateral mycotic intracavernous
aneurysms also occur. Bilateral giant cavernous ICA
aneurysms with
carotid-cavernous fistula (CCF) consequent to
rupture into the cavernous sinus in a case of TA are extremely unusual. We report a case that fulfilled both American College of Rheumatology and European League against Rheumatology criteria for TA. The patient had bilateral cavernous sinus giant
aneurysms and CCF because the right-sided
aneurysm had ruptured and was leaking into the cavernous sinus.