Giant Cell Arteritis

Abstract

Giant cell arteritis (GCA) is a medium and large-vessel vasculitis, which is an important cause of secondary headache in older adults. While GCA has a classic presentation occurring after the age of 50, atypical presentations (eg, fever of unknown origin, cough, low or normal erythrocyte sedimentation rate) may lead to a delay in diagnosis. The topography of vascular involvement has implications for disease-related complications, which can result in neurologic disease at multiple levels of the nervous system. The most feared complication, vision loss, fortunately becomes uncommon after initiation of corticosteroids. Corticosteroid treatment should not be withheld while waiting the results of a temporal artery biopsy (TAB), which remains the gold standard for GCA diagnosis. Newer diagnostic modalities, including ultrasound, magnetic resonance imaging, and positron emission tomography can play an important role in directing treatment in cases with negative TAB. After successful control of the disorder, patients should be gradually tapered off corticosteroids, with careful monitoring using both clinical and laboratory parameters to assess for relapse. Corticosteroid-related treatment complications are not uncommon in GCA. There is mixed evidence for use of adjunct corticosteroid-sparing agents (eg, methotrexate), although these should be initiated in the setting of corticosteroid-related morbidity and/or cases with frequent relapse.

Case report: giant cell arteritis in a patient with carotid atherosclerosis – a diagnostic dilemma

“…This fact is supported by a literature review on previously reported cases [1]. Therefore, GCA should be presumed as a possibility in all elderly patients more than 50 years of age who present with a new-onset headache and vision changes [2]. A high clinical suspicion should be maintained in such individuals while understanding the subtle clinical differences in GCA and carotid atherosclerosis such as vascular distribution and ophthalmological findings.…”

“…However, non-atherosclerotic carotid disease can have similar symptoms with rather uncommon causes such as giant cell arteritis (GCA) [2,4]. …”

Headache: When to Worry

“…Incidence increases with age as 15-25 cases per 100,000 have been reported in individuals aged more than 50 yrs [24] and it increased to 44.7 per 100,000 in individuals aged more than 80 yrs [25]. The scandinavian population has been shown to have a higher incidence rate as compared to any other population [26].…”

“…These symptoms can be seen simultaneously in both eyes or in progression with one eye being affected before the other. Vision loss is the most prevalent complication of GCA and makes this condition an emergency [26]. Other neurologic symptoms include stroke, dementia and neuropathy [27].…”

Issues in the Treatment of Neurological Conditions Caused by Reactivation of Varicella Zoster Virus (VZV)

“…Giant cell arteritis (GCA) is one of the most important neurological diseases because of its potential to cause sudden and irreversible blindness and other central nervous system complications, making prompt diagnosis and immediate initiation of corticosteroid therapy a medical emergency [30]. GCA is characterized pathologically by inflammation in and damage to the vessel wall of the temporal arteries (TAs) [31,32].…”