Ocular manifestations of giant cell arteritis

Hayreh, Sohan Singh; Podhajsky, Patricia; Zimmerman, Bridget

doi:10.1016/s0002-9394(99)80192-5

Cited by 505 publications

(435 citation statements)

References 27 publications

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“…Amaurosis fugax is an important early visual symptom in GCA which can be seen in up to 30% of patients as reported by Hayreh et al [7,8]. Similar visual manifestations were observed in our patient in whom an ophthalmological exam, if done earlier, might have helped in making the right diagnosis.…”

Section: Discussionsupporting

confidence: 89%

Case report: giant cell arteritis in a patient with carotid atherosclerosis – a diagnostic dilemma

Fayyaz

2018

Journal of Community Hospital Internal Medicine Perspectives

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Carotid atherosclerosis and giant cell arteritis (GCA) are two distinct medical conditions with an overlapping clinical spectrum of vascular symptoms such as vision loss and ischemic stroke. This is because both diseases cause arterial ischemia with a predilection for carotid vasculature. In addition, high-vascular risk individuals who are diagnosed with GCA are usually elderly with age >55 years with high-vascular risk and thus can have underlying atherosclerosis. All these factors can pose a diagnostic dilemma for the physicians as GCA is a medical emergency which if left untreated can result in significant morbidity and mortality. Thus, it is important to avoid attributing occlusive arterial disease in elderly patients to atherosclerosis alone because some may have GCA. We present a case report in which presence of diffuse atherosclerosis was a major pitfall while making a timely diagnosis of GCA.

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Section: Discussionsupporting

confidence: 89%

Case report: giant cell arteritis in a patient with carotid atherosclerosis – a diagnostic dilemma

Fayyaz

2018

Journal of Community Hospital Internal Medicine Perspectives

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“…The case also emphasizes the importance of a careful physical examination, as the rash of secondary syphilis on the patient's palms was readily apparent on closer inspection. Anterior ischemic optic neuropathy (AION) is the most common ocular manifestation of GCA, reported in up to 80% of patients with GCA-related ocular involvement, and it is usually caused by vasculitis of the posterior ciliary arteries (2). Central retinal artery occlusion is the second most common ocular manifestation of GCA, occurring in an estimated 5-15% of patients with ocular involvement.…”

Section: Discussionmentioning

confidence: 99%

“…It is the most common ocular manifestation of giant cell arteritis (GCA), occurring in up to 80% of patients with GCA who have visual involvement (2). His symptoms of proximal more than distal myalgias and stiffness raise the possibility of polymyalgia rheumatica (PMR) accompanying GCA.…”

Section: Ischemic Etiologiesmentioning

confidence: 99%

A 56‐Year‐Old Man With Visual Changes and Arthralgias

Goglin

Manesh

Graf

2017

Arthritis Care & Research

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A 56-year-old white male presented with several months of visual changes and diffuse myalgias. He reported difficulty seeing out of the lower portion of his left eye for several months, which he described as "cigarette smoke clouding [his] vision." He also reported mild discomfort with movement of the affected eye. He attributed the visual loss to potential injury during his work as a welder. In addition, he complained of several months of diffuse body pain and stiffness and generalized malaise. The pain and stiffness were worse in his shoulders and hips and were worse in the morning, with improvement by the middle of the day. On some days, these symptoms were so severe that he was unable to go to work. He also noted a vague bitemporal headache, worse on the left than the right. Past medical historyHis past medical history was notable for recently diagnosed type 2 diabetes mellitus, for which he was prescribed metformin. Social and family historyHe was born in the US and had spent the majority of his life in San Francisco. He worked as a manager and welder in an automobile repair shop. He lived alone and was sexually active with multiple female partners. He abused methamphetamines. He denied alcohol or tobacco use. His family history was unremarkable. Review of systemsHe had no fevers or night sweats and his weight was stable. He had no scalp tenderness or jaw or tongue claudication. He had no eye redness. He had no chest pain, dyspnea, or cough. He denied any rashes. Physical examinationHe was afebrile with an oral temperature of 37.1°C. His blood pressure was 126/76 mm Hg, his pulse was 87 beats per minute, his respiratory rate was 16 breaths per minute, and his room air oxygen saturation was 100%. His conjunctivae were not injected and anicteric. His extraocular movements were intact. His visual acuity was 20/20 on the right and 20/25 on the left. He had a sluggish left pupillary reflex and 30% red desaturation of the left eye. He had an inferior field defect on the left. On funduscopic examination he had left optic disc swelling. Photographs of his funduscopic examination are shown in Figures 1 and 2. His temporal arteries were pulsatile and nontender. His neck was supple, and he had no meningeal signs. His cardiac examination was regular with no murmurs, rubs, or gallops. His carotid, brachial, radial, and femoral pulses were 2+. His lungs were clear to auscultation. His abdomen was soft and without organomegaly. He had no synovitis or joint effusions and had full range of motion in all of his joints. He had no palpable cervical, axillary, or inguinal lymph nodes.

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“…In NA-AION, because there is only transient nonperfusion or hypoperfusion in the ONH circulation, there is usually much less severe and less extensive ONH damage than in arteritic AION due to thrombotic occlusion of the posterior ciliary artery [21]. Two large studies [22,23] have shown that 41% of NA-AION eyes show spontaneous visual acuity improvement.…”

Section: Pathogenesis Of Na-aionmentioning

confidence: 99%