Giant cell arteritis with simultaneous onset of multiple intracranial vascular occlusions: A case report

Abstract

Background: Giant cell arteritis (GCA) causes severe stenosis or occlusion of the arteries but rarely affects the intracranial arteries. We report a rare case of GCA along with autopsy results. Case Description: A 69-year-old man developed gait disturbance due to vertebral artery (VA) occlusion. As is common in atherothrombotic stroke, dual antiplatelet therapy was administered. The patient’s symptoms improved temporarily. However, his symptoms relapsed and his consciousness was acutely disturbed. Digital subtraction angiography revealed an appearance of stenosis of the internal carotid artery (ICA) C2 portion on the right side and decreased retrograde basilar artery (BA) blood flow through the right posterior communicating artery. Balloon angioplasty was performed, and BA blood flow increased. GCA was suspected, and a definitive diagnosis was made based on temporal artery biopsy findings. Steroid therapy was initiated but failed to control disease progression, and the patient died. The autopsy findings revealed GCA in the bilateral ICAs and VAs, and no signs of GCA were found in other intracranial arteries, despite occlusion on magnetic resonance angiography. Conclusion: GCA of the intracranial blood vessels is rare and might be more likely to occur in the ICAs and VAs than in other intracranial blood vessels. GCA of the intracranial blood vessels has a poor prognosis, and as such, if rapid changes are observed in the ICAs or VAs, GCA should be considered a part of the differential diagnosis and immediate treatment should be administered.

Ocular Complications of Giant Cell Arteritis: An Acute Therapeutic Emergency

“…Indeed, the intracranial arteries and the orbital arteries located inside the optic nerve sheath and the eyeball have little or no elastic tissue [ 15 ]. These histopathological data described in 1972 were again observed in more recently reported autopsy cases [ 16 , 17 ].…”

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

“…Severe stroke does not necessarily mean cerebral arteritis but rather reflects proximal cervical occlusion. Autopsy of a steroid-resistant case with progressive occlusion of the vertebral and carotid arteries and diffuse brain stroke failed to demonstrate any thrombosis in the brain and cerebellar arteries ( 200 ).…”

“…Stenosis or occlusion may persist after treatment initiation ( 132 , 166 , 167 , 215 – 217 ) or variably regress, from partial change ( 30 , 46 , 168 , 218 ), to complete re-permeabilization ( 173 , 194 , 219 – 223 ). However, stenosis sometimes appears or worsens after steroid and/or TCZ initiation ( 44 , 86 , 137 , 166 , 200 ).…”

“…Balloon dilatation was performed in a few patients, sometimes on multiple arteries and/or several times in the same subjects (166,175,225). Dilatation of severe stenosis immediately improved the clinical signs (200,217). Post-catheter dissection occurred in two cases (225).…”

Giant cell arteritis with severe intracranial involvement diagnosed and treated early

“…In fact, in multiple case reports on intracranial GCA, including the present case, patients were diagnosed with atherothrombotic brain infarction at the onset of cerebral infarction and received standard treatment. [ 7 , 14 ] In patients with GCA, evaluating intracranial vessels as a control is useful for distinguishing them from arteriosclerotic lesions at the onset of CVA. In patients with CVA, it is also necessary to perform medical examinations with GCA in mind.…”