Atypical presentation of giant cell arteritis in a patient with vertebrobasilar stroke: A case report

Medicine
Ahmed Mohamed ElhfnawyPeter Kraft

Abstract

Giant cell arteritis (GCA) is known to present with typical manifestations like temporal headache and visual abnormalities. However, several cases with atypical manifestations were reported. Stroke occurs in 3% to 7% of patients with GCA. A 67-year-old male patient with known hypertension presented with somnolence, disorientation and mild bilateral limb ataxia. The magnetic resonance imaging showed multiple acute infarctions in the territory of the vertebrobasilar system with occlusion of the left vertebral artery. Ten months later, during a routine neurovascular follow-up, recanalization of the left vertebral artery was observed and a hypoechoic concentric "halo" sign around both vertebral arteries, mainly on the left side was evident. On further examination of the superficial temporal artery, a hypoechoic concentric "halo" sign was also found, which-along with increased inflammatory markers-raised suspicion about GCA. Classical GCA features like headache, temporal tenderness or amaurosis fugax were not present. Repeated in-depth diagnostic work-up including 48 hours Holter-ECG did not reveal another stroke etiology. Intravenous Methylprednisolone 250 mg/d was immediately started and after 6 days the dose was tapered to 80 mg/...Continue Reading

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Citations

Mar 15, 2020·Journal of Neuroradiology. Journal De Neuroradiologie·John C BensonWaleed Brinjikji
Jun 15, 2021·Curēus·Mansoor QureshiLatha Ganti

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Methods Mentioned

BETA
biopsy
ESR

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