Giant Cell Arteritis Causing Symmetric Bilateral Posterior Circulation Infarcts

Mackay, Devin D.; Huesmann, Graham R.; Wu, Roseann I.; Stone, James R.; Pless, Misha

doi:10.1097/rhu.0b013e3182a6ffc1

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…With respect to the vasculature pattern, GCA is characterized by subacute granulomatous inflammation of the aorta and its major branches with particular tropism for the extracranial carotid artery branches in patients >50 years of age. 13 The pattern of arterial involvement in 12 autopsy cases demonstrated that the presence of arterial segments showing significant elastic tissue in the media and external elastic lamina was correlated with increased artery involvement. 14 Therefore, the cerebrovascular ischemic events in patients with GCA have been reported to be caused by involvement of extradural vertebral and carotid arteries with high-grade stenosis or occlusions, wherein the elastic fibers are more abundant than those in the intracranial arteries.…”

Section: Discussionmentioning

confidence: 99%

Clinical comparisons of patients with giant cell arteritis with versus without fever at onset

et al. 2019

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Objective Giant cell arteritis (GCA) is the most common systemic vasculitis in individuals aged ≥50 years. Some patients with GCA who develop fever at onset without typical ischemic manifestations may be misdiagnosed with fever of unknown origin. Methods In the present study, we retrospectively evaluated the clinical records of patients with GCA. Patients with and without fever at onset were compared. Results This study included 91 patients with GCA, 55 of whom had fever at onset. The patients with fever at onset showed a lower frequency of jaw claudication and arthralgia and a higher percentage of constitutional symptoms than patients without fever. Additionally, their laboratory results revealed a lower percentage of positive anti-neutrophil cytoplasmic antibody. Furthermore, a lower proportion of affected intracranial vessels was found in patients with fever at onset. Finally, the proportion of biopsy-positive cases was higher in patients with than without fever at onset. Conclusions In this study, 60.4% of patients with GCA had fever at onset. Patients in this group usually had more severe inflammation with a potentially lower risk of ischemic accidents of the central nervous system than patients without fever at onset.

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Section: Discussionmentioning

confidence: 99%

Clinical comparisons of patients with giant cell arteritis with versus without fever at onset

et al. 2019

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“…At GCA onset, CRP is very rarely normal [below ≤ 2.5% ( 81 , 82 )]. It is typically associated with optic signs and rises rapidly within a few days ( 83 ). Combined normal CRP and ESR occurs in <1.2% of cases ( 84 ).…”

Section: Resultsmentioning

confidence: 99%

Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy?

Bonnan,

Debeugny

2023

Front. Neurol.

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Stroke is a rare and severe complication of giant cell arteritis (GCA). Although early diagnosis and treatment initiation are essential, the mechanism of stroke is often related to vasculitis complicated by arterial stenosis and occlusion. Its recurrence is often attributed to early steroid resistance or late GCA relapse, so immunosuppressive treatment is often reinforced. However, many questions concerning the mechanisms of stroke remain elusive, and no review to date has examined the whole data set concerning GCA-related stroke. We therefore undertook this scoping review. GCA-related stroke does not necessarily display general signs and inflammatory parameters are sometimes normal, so clinicians should observe caution. Ischemic lesions often show patterns predating watershed areas and are associated with stenosis or thrombosis of the respective arteries, which are often bilateral. Lesions predominate in the siphon in the internal carotid arteries, whereas all the vertebral arteries may be involved with a predominance in the V3-V4 segments. Ultrasonography of the cervical arteries may reveal edema of the intima (halo sign), which is highly sensitive and specific of GCA, and precedes stenosis. The brain arteries are spared although very proximal arteritis may rarely occur, if the patient has microstructural anatomical variants. Temporal artery biopsy reveals the combination of mechanisms leading to slit-like stenosis, which involves granulomatous inflammation and intimal hyperplasia. The lumen is sometimes occluded by thrombi (<15%), suggesting that embolic lesions may also occur, although imaging studies have not provided strong evidence for this. Moreover, persistence of intimal hyperplasia might explain persisting arterial stenosis, which may account for delayed stroke occurring in watershed areas. Other possible mechanisms of stroke are also discussed. Overall, GCA-related stroke mainly involves hemodynamic mechanisms. Besides early diagnosis and treatment initiation, future studies could seek to establish specific preventive or curative treatments using angioplasty or targeting intimal proliferation.

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“…4 In der Literatur wird generell ausgeführt, dass die Riesenzellarteriitis mit Steroiden gut behandelt werden kann. Der hier dargestellte Fall zeigt aber, dass bei diesem Krankheitsbild auch steroidrefraktäre Verläufe möglich sind [3,9].…”

Section: Kasuistikenunclassified

Hirnstamminfarkt, temporaler Kopfschmerz und erhöhte Entzündungsparameter bei einem 74-jährigen Patienten

et al. 2016

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We report the case of a 74 year old man with a brain stem infarction, temporal headache and elevated inflammatory parameters. Giant cell arteritis with involvement of the temporal and vertebral arteries was proven by histology, duplex sonography and MRI. Although intensive immunosuppressive therapy was started, the patient developed two brain infarcts within 6 months. Initially, C‑reactive protein and erythrocyte sedimentation rate were significantly elevated, but normalized over time. Involvement of the vertebral artery in giant cell arteritis is thought to be rare; steroid refractory courses are very rare. Brain stem infarction might be the consequence.

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Giant Cell Arteritis Causing Symmetric Bilateral Posterior Circulation Infarcts

Cited by 3 publications

References 10 publications

Clinical comparisons of patients with giant cell arteritis with versus without fever at onset

Clinical comparisons of patients with giant cell arteritis with versus without fever at onset

Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy?

Hirnstamminfarkt, temporaler Kopfschmerz und erhöhte Entzündungsparameter bei einem 74-jährigen Patienten

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