Steroid Refractory Giant Cell Arteritis with Bilateral Vertebral Artery Occlusion and Middle Cerebellar Peduncle Infarction

Healy, Sarah; Simpson, Mark P.; Kitchen, William John; Jacob, Anu; Crooks, Daniel; Rathi, Nitika; Biswas, Shubhabrata; Fletcher, Nicholas; Huda, Saif; Sekhar, Alakendu

doi:10.4997/jrcpe.2019.206

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…Among the other 63 patients, one patient died during hospital admission and the other one died around two months after discharge. Of note, stroke recurrence among patients with GCA, despite immunotherapy, is reported [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Red flags for a concomitant giant cell arteritis in patients with vertebrobasilar stroke: a cross-sectional study and systematic review

et al. 2020

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Giant cell arteritis (GCA) may affect the brain-supplying arteries, resulting in ischemic stroke, whereby the vertebrobasilar territory is most often involved. Since etiology is unknown in 25% of stroke patients and GCA is hardly considered as a cause, we examined in a pilot study, whether screening for GCA after vertebrobasilar stroke might unmask an otherwise missed disease. Consecutive patients with vertebrobasilar stroke were prospectively screened for GCA using erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin, and halo sign of the temporal and vertebral artery on ultrasound. Furthermore, we conducted a systematic literature review for relevant studies. Sixty-five patients were included, and two patients (3.1%) were diagnosed with GCA. Patients with GCA were older in age (median 85 versus 69 years, p = 0.02). ESR and CRP were significantly increased and hemoglobin was significantly lower in GCA patients compared to non-GCA patients (median, 75 versus 11 mm in 1 h, p = 0.001; 3.84 versus 0.25 mg/dl, p = 0.01, 10.4 versus 14.6 mg/dl, p = 0.003, respectively). Multiple stenoses/occlusions in the vertebrobasilar territory affected our two GCA patients (100%), but only five (7.9%) non-GCA patients (p = 0.01). Our literature review identified 13 articles with 136 stroke patients with concomitant GCA. Those were old in age. Headache, increased inflammatory markers, and anemia were frequently reported. Multiple stenoses/occlusions in the vertebrobasilar territory affected around 70% of stroke patients with GCA. Increased inflammatory markers, older age, anemia, and multiple stenoses/occlusions in the vertebrobasilar territory may be regarded as red flags for GCA among patients with vertebrobasilar stroke.

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Section: Discussionmentioning

confidence: 99%

Red flags for a concomitant giant cell arteritis in patients with vertebrobasilar stroke: a cross-sectional study and systematic review

et al. 2020

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“…The outcome is usually poor, with a significant reduction of both survival and remission-free survival, Reumatologia 2021; 59/2 despite high dosage of steroids [4,20] and immunosuppressants, such as cyclophosphamide (CFX) [21], methotrexate (MTX) [8], rituximab (RTX) [9] and, more recently, tocilizumab (TCZ) [9,22,23].…”

Section: Discussionmentioning

confidence: 99%

Giant cell arteritis presenting as a stroke in the internal carotid artery territory: a case-based review

Conticini¹,

Falsetti²,

Bardelli³

et al. 2021

Reumatologia

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Giant cell arteritis (GCA) is a large-vessel vasculitis, typically affecting the aorta and its branches. The involvement of vertebral and internal carotid arteries occurs in a limited number of cases, and stroke as a presenting symptom of GCA is extremely unusual: this subset of the disease has a poor prognosis and rarely responds to immunosuppression. We report the case of a 70-year-old woman, who presented to the Emergency Department for ischemic stroke, which appeared to be the first and only symptom of GCA. The prompt administration of steroids and tocilizumab (TCZ) led to clinical and radiological resolution, with no residual disability at 6-month follow-up. Our case-based review, highlighting the rarity of a large vessel vasculitis presenting only with a cerebrovascular accident, provides new evidence for the efficacy of TCZ even in more unusual varieties of GCA: in these cases, TCZ should be immediately prescribed, in order to prevent mortality and severe long-term morbidity.

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“…Why does this still happen? Healy et al 21 report a man, aged 72 years, in whom corticosteroid treatment for giant cell arteritis (GCA) did not prevent further cerebellar infarction from bilateral vertebral artery occlusion and infarcts, both already evident on MRI and CT angiography at presentation and before treatment. He gave a 10-month history of jaw claudication, scalp tenderness and general malaise.…”

Section: Delay In Diagnosing and Treating Giant Cell Arteritismentioning

confidence: 99%

If Case Reports be the Food of Knowledge, Write On: Our Cases of the Quarter

Slater

2020

Journal of the Royal College of Physicians of Edinburgh

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The value of publishing case reports has long been debated and the arguments are summarised. Last year, to encourage trainees, the Royal College of Physicians of Edinburgh's Senior Fellows Club inaugurated an annual prize for the best case report or case series published in the Journal of the Royal College of Physicians of Edinburgh by a doctor in training. Some of the highlights of last year's entries are reviewed, commented on and developed. They include cases of myelofibrosis and cherubism due to secondary hyperparathyroidism from renal failure; reversible blindness in diabetic ketoacidosis; the long QT syndrome; ictal asystole; giant cell arteritis; tumour necrosis factor-a inhibition in Lyme borreliosis; and cannabis hyperemesis syndrome.

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Steroid Refractory Giant Cell Arteritis with Bilateral Vertebral Artery Occlusion and Middle Cerebellar Peduncle Infarction

Cited by 4 publications

References 19 publications

Red flags for a concomitant giant cell arteritis in patients with vertebrobasilar stroke: a cross-sectional study and systematic review

Red flags for a concomitant giant cell arteritis in patients with vertebrobasilar stroke: a cross-sectional study and systematic review

Giant cell arteritis presenting as a stroke in the internal carotid artery territory: a case-based review

If Case Reports be the Food of Knowledge, Write On: Our Cases of the Quarter

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