Giant cell arthritis is a systemic vasculitis. A 51‐year‐old man was presented with sudden onset of right‐side blurred vision, frozen movements, and ptosis in the right eye and left side paresis. The diagnosis of GCA with first manifestations of stroke and carotid dissection may be neglected as an underlying cause.

Introduction: Giant Cell Arteritis (GCA) is a systemic vasculitis that involves medium-sized and larger arteries.GCA rarely can affect the brain-arteries, resulting in ischemic strokes and transient ischemic attacks, whereby the most affected region is vertebrobasilar. Also, it's very unusual that cocurate with large artery dissections. We describe a patient with anterior brain territory stroke and right internal carotid dissection as the first manifestation of GCA.Case report: A 51-year-old man was presented with sudden onset of right-side blurred vision, frozen movements, and ptosis in the right eye and left side paresis. There was a history of right-sided frontotemporal headache, diabetes mellitus, and dyslipidemia. The Laboratory tests show erythrocyte sedimentation rate (ESR)=90, C-reactive protein (CRP)=15mg/L. CT scan and brain MRI indicated an acute ischemic infarction in the right frontal region. CT-Angiography has shown internal carotid artery dissection. Due to the presentation and lab tests, we started Methylprednisolone 1 gr for treating GCA, and temporal artery biopsy was positive for GCA in pathology findings. After ten days, inflammatory markers were reduced (ESR:40). Besides improving headaches, there was no significant change in eye deficits and reduction of left limb's force.Conclusion: Due to the noisy symptoms in patients with Stroke and carotid dissection, the diagnosis of GCA may be neglected as an underlying cause. The association of high CRP levels and the rate of ESR with Stroke, although nonspecific, should draw some attention to vasculitis, topped by GCA.