Artérite à cellules géantes révélée par des nodules cotonneux

Daudin, J.-B.; Bluwol, E.; Chaîne, G.; Rohart, C.

doi:10.1016/s0181-5512(06)73912-2

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…Cotton-wool spots on the retina are usually associated with vasculitis but small retinal vessels are spared by GCA. The authors hypothesized that microemboli may have given rise to these lesions ( 233 ), but direct proof was lacking.…”

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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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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“…Indeed, although rare, the presence of uveitis or isolated ocular ischemia can constitute the first ophthalmic signs of GCA. 4–6…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, GCA can also present with progressive and indolent ocular ischemia. However, not many case reports in the literature 5,11,12 describe cotton wool spots as the first sign of the disease.…”

Section: Discussionmentioning

confidence: 99%

When the picture masks the diagnosis - an atypical and severe giant cell arteritis case report

Moleiro

Vilares-Morgado

Falcão‐Reis

et al. 2023

RETINAL Cases &Amp; Brief Reports

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Purpose: The purpose of this study was to describe an atypical and severe case of giant cell arteritis (GCA).Methods: This was a case report description.Results: The authors report the case of a 76-year-old man who presented with severe and progressive bilateral visual loss. On presentation at the ophthalmology emergency room, the patient's right eye (OD) displayed aqueous flare, hyphema, rubeosis iridis, and dense posterior capsular opacification. After YAG laser capsulotomy, vitreous densifications, intraretinal hemorrhages, cotton wool spots, retinal ischemia, and vasculitis were observed in the fundoscopy. The patient's left eye (OS) also presented intraretinal hemorrhages and cotton wool spots around the temporal arcades. The diagnostic workup excluded infectious diseases, demyelinating diseases, and ocular ischemic syndrome due to carotid obstruction. Proteinogram revealed a monoclonal gammopathy, suggesting a possible hematologic condition. High-dose corticotherapy was initiated, which improved the vitreous densifications and enabled the visualization of the pale optic disk. The remaining study did not confirm the diagnosis of hematologic disease. During follow-up, bilateral VA deteriorated, with the development of progressive pallor in the OS optic disk. Follow-up fluorescein angiography demonstrated progressive retinal and choroidal ischemia. Finally, owing to high clinical suspicion, temporal artery Doppler ultrasound was performed, confirming the diagnosis of GCA.Conclusion: GCA may present multiple ocular features. The knowledge of these different presentations, including retinal and choroidal ischemia or uveitis, is critical for timely diagnosis and treatment initiation. Since patients with GCA often present with vision loss, ophthalmologists may be the first medical doctors who contact with these patients, being on the frontline of GCA diagnosis.

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Ophthalmic Manifestations of Giant Cell Arteritis

Hayreh

2011

Ischemic Optic Neuropathies

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Artérite à cellules géantes révélée par des nodules cotonneux

Cited by 5 publications

References 8 publications

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

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

When the picture masks the diagnosis - an atypical and severe giant cell arteritis case report

Ophthalmic Manifestations of Giant Cell Arteritis

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