Inflammatory Pseudo-tumour Orbitae (PTO): An Atypical Manifestation of Giant Cell Arteritis (GCA)

Hittinger, M.; Berlis, Ansgar; Pfadenhauer, K.

doi:10.1007/s00062-014-0346-y

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…This confirms that GCA may appear with highly variable clinical forms and situations, making diagnosis difficult. An atypical presentation of the disease with the unusual clinical manifestation is being confirmed in the current literature, what reminds about the serious problem with underdiagnosis or inadequate management assessing the so-called “masked GCA” [ 19 – 21 ]. The authors of publications cited above specify the orofacial manifestations present with a variety of related clinical signs and symptoms as the most common clinical reasons for the delay of diagnosis or misdiagnosis of Horton’s disease especially in older persons.…”

mentioning

confidence: 82%

Horton’s disease: still an important medical problem in elderly patients: a review and case report

Gomułka¹,

Radzik-Zając²,

Zaleska-Dorobisz³

et al. 2017

pdia

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mentioning

confidence: 82%

Horton’s disease: still an important medical problem in elderly patients: a review and case report

Gomułka¹,

Radzik-Zając²,

Zaleska-Dorobisz³

et al. 2017

pdia

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“…Finding 4 may suggest inflammatory, infiltrative, or demyelinating chiasmopathy. 2,5,[7][8][9][10][11][12][18][19][20][21][22] Clinicians should be aware of the radiographic findings in GCA and, although further testing may be required to exclude alternative etiologies, diagnosis and treatment should not be unnecessarily delayed.…”

Section: Optic Chiasmal Enhancement To Our Knowledge Oursmentioning

confidence: 99%

“…In addition, orbital inflammatory signs and symptoms can occur, mimicking idiopathic orbital inflammatory syndrome or other infectious/inflammatory etiologies. [4][5][6][7][8] Furthermore, MRI abnormalities including T2 hyperintensity, diffusion-weighted imaging restriction, and gadolinium enhancement may occur in GCA-related AION or PION, broadening differential diagnosis. 2,4,[7][8][9][10] Previously described MRI findings, noted in Table 1, include dural and perineural sheath enlargement, sheath and nerve enhancement, and extracranial and intracranial vascular changes.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging findings in giant cell arteritis

D’Souza

Morgan

Almarzouqi

et al. 2016

Eye

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PurposeGiant cell arteritis (GCA) is a systemic vasculitis that affects medium-to-large-caliber arteries. Early diagnosis and treatment is essential as involvement of the ophthalmic artery or its branches may cause blindness. Radiographic findings may be variable and non-specific leading to delay in diagnosis. We conducted a review of the literature on neuroimaging findings in GCA and present a retrospective case series from tertiary-care ophthalmic referral centers of three patients with significant neuroimaging findings in biopsy-proven GCA.MethodsRetrospective case series of biopsy-proven GCA cases with neuroimaging findings at the Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital between 2010-2015 were included in this study. Literature search was conducted using Google Scholar and Medline search engines between the years 1970 and 2015.ResultsWe report findings of optic nerve enhancement, optic nerve sheath enhancement, and the first description in the English-language ophthalmic literature, to our knowledge, of chiasmal enhancement in biopsy-proven GCA. We describe four main categories of neuroimaging findings that may be seen in GCA from our series and from past cases in the literature.DiscussionIt is essential that clinicians be aware of the possible radiographic findings in GCA. Appropriate and prompt treatment should not be delayed based upon these findings.

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“…Clinical outcomes were reported in 48% of the cases. Follow-up ranged from 7 days [35] to 3 months [37]. When reported, ophthalmologic outcomes improved (9%), remained stable (33%), or worsened (7%) at follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…Additional areas of future investigation include whether MRI could help determine when corticosteroids/immunomodulatory treatments could be tapered, if MRI can detect relapse or whether MRI has a prognostic role for determining ophthalmologic outcomes. Several cases [21; 30; 35; 37; 38] reported resolution of pathologic enhancement on orbital MRI and improvement in visual function/symptoms while another case [25] reported no visual functional improvement despite imaging resolution. Alternatively, optical coherence tomography/-angiography can image the retinal layer and assess microvascular changes, respectively.…”

Section: Discussionmentioning

confidence: 99%

Orbital Magnetic Resonance Imaging of Ocular Giant Cell Arteritis: A Systematic Review and Individual Participant Data Meta-Analysis

Guggenberger

Pavlou

Cao

et al. 2022

Preprint

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Objectives: Spectrum and prevalence of orbital MRI findings in patients with giant cell arteritis with ischemic optic neuropathy are unknown. We conducted a systematic review and individual participant data meta-analysis of publications reporting the ophthalmologic presentation, clinical exam, and orbital MRI findings in ocular giant cell arteritis. Methods: PubMed and Cochrane databases were searched from inception to January 16, 2022. Publications reporting patient-level data on patients with ophthalmic symptoms, imaged with orbital MRI and diagnosed with biopsy-proven giant cell arteritis were included. Demographics, clinical symptoms, exam, lab, imaging, and outcomes data were extracted. Descriptive statistics were used to report prevalence rates. Methodological quality and completeness of reporting of the case reports were assessed. Results: Thirty-two studies were included comprising 51 patients (females=24; median age, 76 years). Vision loss (78%) and headache (45%) were commonly reported visual and cranial symptoms. Ophthalmologic presentation was unilateral (41%) or bilateral (59%). Fundus examination most commonly showed disc edema (64%) and pallor (49%). Average visual acuity was very poor (2.28 logMAR ± 2.18). Diagnoses included anterior (61%) and posterior (16%) ischemic optic neuropathy, central retinal artery occlusion (8%) and orbital infarction syndrome (2%). Erythrocyte sedimentation rate and c-reactive protein were elevated in 83% and 42% of cases, respectively. On MRI, enhancement of the optic nerve sheath (53%), intraconal fat (25%), and optic nerve/chiasm (14%) was most prevalent. Among patients with monocular visual symptoms, 38% showed pathologic enhancement in the asymptomatic orbit. Six of seven cases reported imaging resolution after treatment on follow-up MRIs. Incomplete reporting were limitations in this study. Conclusions: Vision loss, pallid disc edema, and optic nerve sheath enhancement are the most common clinical, fundoscopic and imaging findings reported in patients diagnosed with ocular giant cell arteritis, respectively. MRI may detect subclinical inflammation in the asymptomatic eye and may be an adjunct diagnostic tool.

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Inflammatory Pseudo-tumour Orbitae (PTO): An Atypical Manifestation of Giant Cell Arteritis (GCA)

Cited by 6 publications

References 9 publications

Horton’s disease: still an important medical problem in elderly patients: a review and case report

Horton’s disease: still an important medical problem in elderly patients: a review and case report

Magnetic resonance imaging findings in giant cell arteritis

Orbital Magnetic Resonance Imaging of Ocular Giant Cell Arteritis: A Systematic Review and Individual Participant Data Meta-Analysis

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