DOI 101212WNL0000000000000549201483e11 Neurology

Timo Siepmann and Ulf Bodechtel Macaroni signImagesTeaching Neuro

This information is current as of June 30 2014

httpwwwneurologyorgcontent831e11fullhtmllocated on the World Wide Web at

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Neurology All rights reserved Print ISSN 0028-3878 Online ISSN 1526-632Xsince 1951 it is now a weekly with 48 issues per year Copyright copy 2014 American Academy of

reg is the official journal of the American Academy of Neurology Published continuouslyNeurology

RESIDENTamp FELLOWSECTION

Section EditorMitchell SV ElkindMD MS

Timo Siepmann MDUlf Bodechtel MD

Correspondence toDr SiepmannTimoSiepmannuniklinikum-dresdende

Download teachingslides Neurologyorg

Teaching NeuroImagesMacaroni sign

A 35-year-old patient with previously diagnosed andcurrently untreated Takayasu arteritis presented withmotor aphasia The symptom had started 24 hoursbefore presentation and ceased after another 12 hoursCranial MRI and magnetic resonance angiography werenormal Plasma concentration of C-reactive protein waselevated (91 mgdL) Duplex ultrasonography showedhypoechoic homogeneous thickening of the intimandashmedia complex of the left common carotid artery(figure) This finding also referred to as ldquomacaronisignrdquo has been reported in Takayasu arteritis12 Thepatient was transferred to the rheumatologic departmentand treatment with prednisolone (80mgday orally) andacetylsalicylic acid (100 mgday orally) was initiated

AUTHOR CONTRIBUTIONSDr Siepmann made substantial contributions to performance and analy-

sis of the ultrasonographic assessment reported in this article as well as

treatment of the patient and drafting the manuscript Dr Bodechtel

made substantial contributions to supervision of diagnostic testing analy-

ses and treatment as well as critical revision of the article for intellectual

content

STUDY FUNDINGNo targeted funding reported

DISCLOSUREThe authors report no disclosures relevant to the manuscript Go to

Neurologyorg for full disclosures

REFERENCES1 Pipitone N Versari A Salvarani C Role of imaging studies

in the diagnosis and follow-up of large-vessel vasculitis an

update Rheumatology 200847403ndash408

2 Maeda H Handa N Matsumoto M et al Carotid lesions

detected by B-mode ultrasonography in Takayasursquos arteritis

ldquomacaroni signrdquo as an indicator of the disease Ultrasound

Med Biol 199117695ndash701

Figure Duplex ultrasonography of the left common carotid artery

Duplex ultrasonography shows thickening of the intimandashmedia complex that results from granulomatous inflammatorychanges of the medium- and large-sized arteries mediated by invasion of giant cells and mononuclear cells The macaronisign therefore suggests active arterial vessel inflammation

From the Department of Neurology Carl Gustav Carus University Hospital Dresden University of Technology Dresden Germany

copy 2014 American Academy of Neurology e11

DOI 101212WNL0000000000000549201483e11 Neurology

Timo Siepmann and Ulf Bodechtel Macaroni signImagesTeaching Neuro

This information is current as of June 30 2014

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