Visual loss and other cranial ischaemic complications in giant cell arteritis

Abstract

Giant cell arteritis (GCA) is the most common form of vasculitis in individuals aged 50 years and over. GCA typically affects large and medium-sized arteries, with a predilection for the extracranial branches of the carotid artery. Patients with GCA usually present with symptoms and signs that are directly related to the artery that is affected, with or without constitutional manifestations. The most dreaded complication of GCA is visual loss, which affects about one in six patients and is typically caused by arteritis of the ophthalmic branches of the internal carotid artery. Before the advent of glucocorticoid treatment, the prevalence of visual complications was high. Increasing awareness by physicians of the symptoms of GCA and advances in diagnostic techniques over the past twenty years have also contributed to a substantial decline in the frequency of permanent visual loss. Ischaemic brain lesions are less common than visual lesions, and mostly result from vasculitis of the extradural vertebral or carotid arteries. In the case of both the eye and the brain, ischaemic damage is thought to result from arterial stenosis or occlusion that occurs secondary to the inflammatory process. The inflammatory response at the onset of arteritis, its role as a predictor of complications and the role of traditional cardiovascular risk factors have been extensively investigated in the past decade. In this Review, the epidemiology, risk factors, clinical presentation and current therapeutic approach of GCA-related ischaemic events are discussed, with a particular emphasis on visual loss.

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

“…Progression to blindness typically occurs within days after initial visual symptoms develop. Funduscopic examination early in the course of AION usually reveals a pale, swollen optic disc, with optic atrophy developing within a few weeks (9).…”

Large-Vessel Vasculitides: Takayasu Arteritis and Giant Cell Arteritis

“…Transient episodes of blurred vision are usually reversible, but sudden and painless irreversible loss of vision may occur if treatment is not started promptly [22]. Permanent loss of vision in GCA results from anterior ischemic optic neuropathy (80% of cases), central or branch retinal arterial occlusion, posterior ischemic optic neuropathy, or, rarely, posterior cerebral ischemia [23]. Loss of vision may be partial or complete and unilateral or bilateral.…”

Wuzang Wenyang Huayu decoction regulates differentially expressed transcripts in the rats' hippocampus after cerebral hypoperfusion

“…Two experimental approaches have evolved: (a) transient occlusion of the middle cerebral artery 6 and (b) permanent occlusion of extracranial vessels, for example carotid arteries. 7 To model chronic cerebral hypoperfusion, permanent bilateral occlusion of the common carotid arteries of rats is usually introduced. This procedure creates a model similar to human dementia developed because of vascular risk factors.…”