Giant cell arteritis (GCA) is a common and inflammatory condition that almost exclusively affect adults older than 50 years. GCA is a systemic vasculitis that involves medium-sized and larger arteries. GCA rarely can affect the brain-arteries, resulting in ischemic strokes and transient ischemic attacks.
We reported a 51-year- old man who presented in our clinic with sudden onset of right-side blurred vision, frozen movements, and ptosis in the right eye and left side paresis. His right pupil was not responding to the light, and the right eye's visual acuity was no light perception. Examination of ocular movements affirms a complete right ophthalmoplegia. Evaluation of the left eye was unremarkable. Spiral brain computed tomography (CT) scan and brain magnetic resonance imaging (MRI) showed multifocal diffusion restricting lesions involving all lobes of the right hemisphere and some involvements in the maxillary sinus that spread to the cavernous sinus. After this report, we promote a CT angiography that shows internal carotid artery dissection. Also, due to the history of ipsilateral frontotemporal headache and the high (ESR:90) level, we started pulse of Methylprednisolone 1 gram daily in suspicion of GCA, and temporal artery biopsy was done after 1 week, which was positive for GCA in pathology findings. After 10 days of administrating corticosteroid therapy, inflammatory markers were reduced (ESR:40). Besides improving headaches, there was no significant change in ptosis and ocular movements, visual acuity, and reduction of left limb's force.
Diagnosis of GCA is critical because delay can cause irreversible loss of vision in patients. Also, it can be challenging for those without the classic symptoms, such as headaches. The diagnosis of GCA with first manifestations of stroke and carotid dissection may be cause misdiagnosis.
What will audience learn from your presentation?
- Giant cell arthritis is a systemic vasculitis. A 51-year-old man was presented with sudden onset of right-side blurred vision, frozen movements, and ptosis in the right eye and left side paresis. The diagnosis of GCA with first manifestations of stroke and carotid dissection may be neglected as an underlying cause.
- When diagnosing stroke in elderly patients, based on the symptoms and paraclinical investigations, we should start treatment immediately before further diagnostic procedures if we suspect GCA and we have to have vasculitis in the further diagnosis.