Lethal giant cell arteritis with multiple ischemic strokes despite aggressive immunosuppressive therapy

Lu-Emerson, Christine; Walker, Melanie; Huber, Bertrand R.; Ghodke, Basavaraj; Longstreth, W. T.; Khot, Sandeep P.

doi:10.1016/j.jns.2010.05.008

Cited by 16 publications

(22 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The survival rate for giant cell arteritis is said to be equivalent to the age-matched population [136]. There are case reports, however, of fulminant GCA and death, despite aggressive therapy with corticosteroids and other immune-modifying agents [137].…”

Section: Giant Cell Arteritismentioning

confidence: 99%

Immune Mediated Diseases and Immune Modulation in the Neurocritical Care Unit

Geldern¹,

McPharlin

Becker

2012

Neurotherapeutics

View full text Add to dashboard Cite

This chapter will review the spectrum of immunemediated diseases that affect the nervous system and may result in an admission to the neurological intensive care unit. Immunomodulatory strategies to treat acute exacerbations of neurological diseases caused by aberrant immune responses are discussed, but strategies for long-term immunosuppression are not presented. The recommendations for therapeutic intervention are based on a synthesis of the literature, and include recommendations by the Cochrane Collaborative, the American Academy of Neurology, and other key organizations. References from recent publications are provided for the disorders and therapies in which randomized clinical trials and large evidenced-based reviews do not exist. The chapter concludes with a brief review of the mechanisms of action, dosing, and side effects of commonly used immunosuppressive strategies in the neurocritical care unit.

show abstract

Section: Giant Cell Arteritismentioning

confidence: 99%

Immune Mediated Diseases and Immune Modulation in the Neurocritical Care Unit

Geldern¹,

McPharlin

Becker

2012

Neurotherapeutics

View full text Add to dashboard Cite

show abstract

“…In one study, eight of 287 patients (2.8%) had strokes between the onset of GCA and 4 weeks after the onset of CS (97). Lesions due to involvement of the vertebrobasilar territory were seen more often than those caused by involvement of the carotids (97,99). Patients with strokes had more commonly permanent visual loss and were more frequently smokers (97).…”

Section: Neurologic Manifestationsmentioning

confidence: 99%

“…In another study (99), the same incidence (2.8%) of strokes was observed, but the internal carotid arteries were involved in 4 patients and the vertebrobasilar arteries in 3. Interestingly, CT and MRI revealed small cerebral and cerebellar infarction, but at necropsy generalized GCA involving medium and cerebral vessels was found in one case (99). Multiple ischemic strokes despite escalating immmunosuppressive therapy may also develop (100, 101), in which both anterior and posterior circulations are involved bilaterally in a characteristic location where the arteries penetrate the dura (100).…”

Section: Neurologic Manifestationsmentioning

confidence: 99%

Diagnosis and Treatment of Giant Cell Arteritis (Temporal Arteritis) – Past, Current and Future Aspects

Gran¹

2011

Advances in the Diagnosis and Treatment of Vasculitis

View full text Add to dashboard Cite

“…GCA can present with a variety of symptoms, including neurological symptoms such as headache, jaw claudication, visual symptoms (diplopia, flimmer scotoma, amaurosis fugax) or cerebrovascular events (transient ischaemic attack and stroke in approximately 2–4% of patients with GCA) 1–4 7 8. These events occur in the vertebrobasilar territory more frequently than in general population (50–75% vs 15–20%) and are secondary to extracranial stenosis and occlusion of internal carotid and/or, more likely, vertebral arteries 2–4 7 8…”

Section: Introductionmentioning

confidence: 99%

“…These events occur in the vertebrobasilar territory more frequently than in general population (50–75% vs 15–20%) and are secondary to extracranial stenosis and occlusion of internal carotid and/or, more likely, vertebral arteries 2–4 7 8…”

Section: Introductionmentioning

confidence: 99%

Extensive intracranial involvement with multiple dissections in a case of giant cell arteritis

et al. 2014

View full text Add to dashboard Cite

SUMMARYA 56-year-old man presented with weight loss, articular pain and minor neurological symptoms progressing over 1 month. Neurosonological evaluation suggested occlusion in intracranial segments of the left vertebral artery (VA) and of both internal carotid arteries (ICA) and hypoechoic halo sign in both superficial temporal arteries. The diagnosis of giant cell arteritis was supported by inflammatory markers and confirmed by biopsy. Despite early steroid initiation, he manifested fluctuant vascular deficits and became lethargic. Brain MRI indicated watershed infarcts and intracranial dissections of left VA and both ICA. The patient was stabilised with the association of prednisolone 2 mg/kg, methotrexate and oral anticoagulation. Since then he has been neurologically asymptomatic and control imaging showed only residual intracranial left VA stenosis, with no signs of temporal artery inflammation or new vascular lesions. This is to the best of our knowledge, the first reported clinical case with such an extensive intracranial involvement with multiple dissections. BACKGROUND

show abstract

Lethal giant cell arteritis with multiple ischemic strokes despite aggressive immunosuppressive therapy

Cited by 16 publications

References 19 publications

Immune Mediated Diseases and Immune Modulation in the Neurocritical Care Unit

Immune Mediated Diseases and Immune Modulation in the Neurocritical Care Unit

Diagnosis and Treatment of Giant Cell Arteritis (Temporal Arteritis) – Past, Current and Future Aspects

Extensive intracranial involvement with multiple dissections in a case of giant cell arteritis

Contact Info

Product

Resources

About