Case Study: Giant Cell Arteritis with Vertebral Artery Stenosis

Chomlak, R. Daniel; Ghazanfari, Farshad; Datta, Mineesh

doi:10.4137/cmamd.s38143

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…Identifying VA involvement in GCA is important as it may result in ischemia in the vertebrobasilar territory, which is associated with high mortality ( 5 ). In our study, stroke at GCA diagnosis was detected in 12/57 patients (21.1%) by brain imaging, which is higher than published stroke rates of 2.4%–2.8% in the literature at the time of GCA diagnosis (between onset of GCA symptoms/signs and 1 month after beginning of GCs therapy) ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

“…In a recent case report of GCA with VA affection, progression of VA stenosis and recurrent stroke despite aggressive immunotherapy (high-dose GCs, cyclophosphamide, TCZ) was observed with a fatal outcome ( 7 ). Case reports with similar clinical course, i.e., recurrent vertebrobasilar ischemia in GCA with VA affection despite intensive immunotherapy with TCZ or cyclophosphamide, have been published ( 5 , 13 , 32 ). In patients with stroke due to progressive GCA who are non-responsive to immunotherapy or in patients with severe symptomatic stenosis based on an underlying inflammatory process, endovascular therapy (EVT) (e.g., angioplasty) may be considered ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

“…Vertebral artery (VA) involvement in GCA is rare compared to the typical affection of the superficial cranial vessels, and only few cases in this patient group have been reported in the literature ( 2 , 4 – 13 ). VA involvement resulting from GCA may lead to progressive brainstem- and/or cerebellar syndromes and is associated with increased mortality rates ( 5 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Giant cell arteritis with vertebral artery involvement—baseline characteristics and follow-up of a monocentric patient cohort

Prünte,

Naumann,

Christ

et al. 2023

Front. Neurol.

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Vertebral artery (VA) involvement in giant cell arteritis (GCA) has rarely been reported. We aimed to evaluate the prevalence, patients’ characteristics, and immunotherapies used in patients with GCA and VA involvement at diagnosis and 1 year follow-up, retrospectively including patients being diagnosed between January 2011 and March 2021 in our department. Clinical features, laboratory data, VA imaging, immunotherapy, and 1 year follow-up data were analyzed. Baseline characteristics were compared to GCA patients without VA involvement. Among all 77 cases with GCA, 29 patients (37.7%) had VA involvement, as diagnosed by imaging and/or clinical signs and symptoms. Gender distribution and erythrocyte sedimentation rate (ESR) were significantly different in the groups with and without VA involvement, with more women being affected (38/48 patients, 79.2%) and a significantly higher median ESR in patients without VA involvement (62 vs. 46 mm/h; p = 0.012). MRI and/or CT showed vertebrobasilar stroke at GCA diagnosis in 11 cases. 67/77 patients (87.0%) received high-dose intravenous glucocorticosteroids (GCs) at diagnosis, followed by oral tapering. Six patients were treated with methotrexate (MTX), one with rituximab, and five with tocilizumab (TCZ). 2/5 TCZ patients achieved clinical remission after 1 year, vertebrobasilar stroke within the first year occurred in 2/5 patients. Diagnosis of VA involvement might be underrecognized in GCA patients. VA imaging should be performed in elderly patients with vertebrobasilar stroke presenting with GCA symptoms, not to miss GCA as the etiology of stroke. Efficacy of immunotherapies in GCA with VA affection and long-term outcomes need to be investigated further.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Giant cell arteritis with vertebral artery involvement—baseline characteristics and follow-up of a monocentric patient cohort

Prünte,

Naumann,

Christ

et al. 2023

Front. Neurol.

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“…The outcome is usually poor, with a significant reduction of both survival and remission-free survival, 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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“…Tan et al [9] reported a case of GCA involving only the occipital artery which was revealed by magnetic resonance angiography. Chomlak et al [10] reported a case of GCA with vertebral artery involvement, which was refractory to immunosuppressives. Hocevar et al [11] claimed that, even early diagnosis and a prompt initiation of steroid did not prevent relapses in GCA.…”

Section: Discussionmentioning

confidence: 99%

A Case of Temporal Arteritis Associated with Atypical Clinical Findings

Asfuroglu¹

2017

JOJO

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Introduction:We describe a case of temporal arteritis associated with a typical clinical findings, that affected both eyes of the patient with in a 1 month interval.Case report: A 63 years old hypertensive male patient applied to our clinic with complaint of vision loss in his right eye for two weeks. His visual acquity was perception of hand movements in right eye. He did not complain of any associated headache, scalp tenderness, jaw claudication or constitutional symptoms such as weight loss, fever, malaise or sweats. We consulted the patient to internal medicine, rheumotology and hematology departments. His clinical and labaratuary findings were unremarkable except thrombocytosis. Following a presumptive diagnosis of non-arteritic ischemic optic neuropathy, the patient was hospitalized and treated with intravenous 1000mg methylprednisolone for 3 days. After 3 days, oral prednisolone therapy was started 60mg per day. Oral steroid therapy was tapered 10mg with 3 days interval. 1 month later, patient presented with sudden vision loss in his left eye. Fundus examination revealed left optic disc swelling and soft exudates near the optic disc. Conclusion:In people older than 55 years, amaurosis fugax or visual loss, development of an acute ocular ischemic lesion with or without elevated erythrocyte sedimentation rate and systemic symptoms, should raise suspicion for giant cell arteritis. Table 1: Symptoms in Giant Cell Arteritis [3].Category Symptoms 5Symptoms due to involvement of cranial vessels Headache Jaw claudication (pain on chewing) Scalp tenderness Loss of vision Abnormalities of the temporal artery

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Case Study: Giant Cell Arteritis with Vertebral Artery Stenosis

Cited by 6 publications

References 12 publications

Giant cell arteritis with vertebral artery involvement—baseline characteristics and follow-up of a monocentric patient cohort

Giant cell arteritis with vertebral artery involvement—baseline characteristics and follow-up of a monocentric patient cohort

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

A Case of Temporal Arteritis Associated with Atypical Clinical Findings

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