Cox Benjamin C, Fulgham Jimmy R, Klaas James P
Department of Neurology, Mayo Clinic, Rochester, MN.
Neurologist. 2019 Jul;24(4):139-141. doi: 10.1097/NRL.0000000000000237.
To describe rare but important cerebrovascular complications of giant cell arteritis (GCA).
We report a 59-year-old man who initially presented with vasculitis of the lower extremities. While on steroids, he developed strokes in multiple vascular territories. The conventional angiogram showed stenosis of bilateral carotid and vertebral vessels as they entered the dura. Temporal artery biopsy confirmed GCA. He began cyclophosphamide treatment, which stabilized his clinical course; however, this was switched to tocilizumab by an outside rheumatologist. Two months later, the patient had progression of vessel stenosis and suffered additional strokes. Despite interventions to augment cerebral perfusion, the infarctions continued to expand and the patient passed away.
This case highlights several important features of strokes in GCA: the predilection for the dural entry point of cerebral blood vessels, the progression of disease despite steroids, and the need to quickly escalate treatment in these cases. As seen in our patient, however, this disease carries high morbidity and mortality and patients often have poor outcomes despite aggressive immunosuppression.
描述巨细胞动脉炎（GCA）罕见但重要的脑血管并发症。
我们报告一名59岁男性，最初表现为下肢血管炎。在使用类固醇治疗期间，他在多个血管区域发生了中风。传统血管造影显示双侧颈动脉和椎动脉进入硬脑膜处狭窄。颞动脉活检确诊为GCA。他开始接受环磷酰胺治疗，临床病程得以稳定；然而，外部风湿病专家将治疗改为托珠单抗。两个月后，患者血管狭窄进展并再次中风。尽管采取了增加脑灌注的干预措施，但梗死灶仍继续扩大，患者最终死亡。
该病例突出了GCA中风的几个重要特征：脑血管硬脑膜入口点的易发性、尽管使用类固醇疾病仍进展以及在这些病例中迅速加强治疗的必要性。然而，正如我们的患者所见，这种疾病具有高发病率和死亡率，尽管进行积极的免疫抑制治疗，患者的预后往往较差。
