Wong Joshua, Chan Siang, Shetty Ashit
Stroke Service, Nottingham University Hospitals NHS Trust, Nottingham, GBR.
Cureus. 2022 Aug 13;14(8):e27961. doi: 10.7759/cureus.27961. eCollection 2022 Aug.
Giant cell arteritis (GCA) is an immune-mediated systemic vasculitis usually seen in the older population. We describe a case of a 75-year-old woman who presented with jaw claudication and temporal headache. A colour duplex ultrasonography and later biopsy of the temporal arteries confirmed GCA and she was commenced on oral steroids. She was subsequently readmitted with a new worsening vision of both eyes and confusion. Her brain images revealed acute bilateral vertebral artery thrombus with haemorrhagic transformation. She was loaded on intravenous steroids. The next day she developed vomiting, bilateral visual loss and a cardiac arrest from ventricular fibrillation. Following the return of spontaneous circulation, she was taken to the cardiac catheterisation laboratory for a coronary angiogram, which showed diffuse thrombus at the apical left anterior descending artery. A bedside echocardiogram revealed a sizable left ventricular thrombus. She was managed with heparin and antiplatelet therapy. This case presented a complex diagnostic dilemma to the medical team as vasculitis, atherosclerosis, and cardiac emboli could have contributed to her stroke and visual loss. This patient also had some vascular risk factors for occlusive cerebrovascular disease, potentially suggesting a clinical event with multiple aetiologies. Stroke and visual loss are rare but serious complications of GCA, which require a high index of suspicion and early treatment with corticosteroids to improve prognosis. Although a temporal artery biopsy remains to be the definitive diagnostic modality for GCA, the use of radiological investigations in the diagnosis of GCA is increasingly common. A non-invasive colour duplex ultrasonography of the temporary arteries could be used to assess GCA in highly suspected patients. Echocardiograms and contrast-enhanced body imaging should be performed in patients with suspected or established GCA to assess for secondary thromboembolic and vascular complications.
巨细胞动脉炎（GCA）是一种免疫介导的系统性血管炎，常见于老年人群。我们报告一例75岁女性，表现为颌部间歇性运动障碍和颞部头痛。彩色双功能超声检查及随后的颞动脉活检确诊为GCA，遂开始口服类固醇治疗。随后她因双眼视力新出现恶化和意识模糊再次入院。脑部影像显示急性双侧椎动脉血栓形成并伴有出血性转化。给予静脉注射类固醇治疗。次日，她出现呕吐、双侧视力丧失，并因心室颤动发生心脏骤停。自主循环恢复后，她被送往心脏导管实验室进行冠状动脉造影，结果显示左前降支动脉心尖部弥漫性血栓形成。床旁超声心动图显示左心室有较大血栓。给予肝素和抗血小板治疗。该病例给医疗团队带来了复杂的诊断难题，因为血管炎、动脉粥样硬化和心脏栓子都可能导致她的中风和视力丧失。该患者还存在一些闭塞性脑血管疾病的血管危险因素，提示可能是多种病因导致的临床事件。中风和视力丧失是GCA罕见但严重的并发症，需要高度怀疑并早期使用皮质类固醇治疗以改善预后。虽然颞动脉活检仍是GCA的确诊诊断方法，但影像学检查在GCA诊断中的应用越来越普遍。对于高度怀疑的患者，可使用颞动脉的无创彩色双功能超声检查来评估GCA。对于疑似或确诊GCA的患者，应进行超声心动图和对比增强体部成像，以评估继发性血栓栓塞和血管并发症。
