Giant cell arteritis presenting as a stroke in the internal carotid artery territory: a case-based review
Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Italy
Data nadesłania: 20-01-2021
Data ostatniej rewizji: 19-02-2021
Data akceptacji: 22-02-2021
Data publikacji online: 27-04-2021
Data publikacji: 28-04-2021
Reumatologia 2021;59(2):121-125
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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