1. A 35-year-old patient with motor aphasia Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology

2. A 35-year-old patient with previously diagnosed and currently untreated Takayasu’s arteriitis presented with motor aphasia. The symptom began 24 hours before presentation and ceased after another 12 hours. Cranial MRI and MR angiography were normal. Plasma concentration of CRP was elevated (9.1 mg/dL). Duplex ultrasonography showed thickening of the intima-media complex of the left common carotid artery. The patient was treatment with prednisolone (80 mg/day orally) and acetylsalicylic acid (100 mg/day orally). Siepmann et al. © 2013 American Academy of Neurology Vignette

3. Siepmann et al. © 2013 American Academy of Neurology Imaging

4. Macaroni Sign The ultrasonographic finding of hypoechoic, homogeneous thickening of the intima-media complex of the left common carotid artery is also referred to as the “Macaroni sign” and has been previously reported in Takayasu`s arteriitis. 1,2 The Macaroni sign results from granulomatous inflammatory changes of the medium- and large-sized arteries mediated by invasion of giant cells and mononuclear cells. The Macaroni sign therefore suggests active arterial vessel inflammation. Siepmann et al. © 2013 American Academy of Neurology