Clinical, paraclinical, therapeutic and evolutionary profiles of stroke in young adults at the Yaounde central hospital: a report of four cases of Takayasu arteritis

Introduction: Ischemic stroke in young individuals is a rare event with devastating consequences. Takayasu arteritis, a large-vessel vasculitis, represents an exceptional but serious etiology. This study aimed to describe the clinical, paraclinical, therapeutic, and outcome profiles of this condition in Yaounde. Methodology: We conducted a single-center descriptive study with prospective data collection at the Yaounde Central Hospital (Cameroon) over a 32-month period (February 2021 - September 2023). Four patients under 50 years of age who met the 1990 ACR criteria for Takayasu arteritis and presented with cerebral infarction were included. Results: The mean age was 23.3 years with a sex ratio of 1. The main presenting complaint was sudden-onset hemiplegia. Clinical examination revealed vascular signs in all cases (absent pulses, blood pressure asymmetry >10 mmHg, and carotid bruits). Imaging (CT/CT angiography/MRI) demonstrated severe stenosis (55-100%), carotid occlusions, aortic aneurysms, and dissections. Biologically, an inflammatory syndrome was consistently present. Treatment consisted of high-dose corticosteroid therapy, combined in recurrent cases with immunosuppressive agents (methotrexate or azathioprine). Outcomes included one death and recurrences related to treatment discontinuation for financial reasons. Quality of life was severely impaired by moderate to severe anxiety and depression in all survivors. Conclusion: Takayasu arteritis should be systematically investigated in cases of stroke in young patients in Cameroon, particularly in the presence of peripheral pulse abnormalities. Multidisciplinary management, including psychological support, is essential to improve functional prognosis and quality of life. Keywords: Ischemic stroke, Young adult, Takayasu arteritis, Cameroon, Quality of life.