Mineji Kentaro, Yako Rie, Toki Naotsugu, Tomobuchi Masaki, Nakao Naoyuki
Department of Neurological Surgery, School of Medicine, Wakayama Medical University, Wakayama City, Japan.
Surg Neurol Int. 2023 Sep 15;14:332. doi: 10.25259/SNI_529_2023. eCollection 2023.
Ischemic cerebrovascular accidents (CVA) occur in 3.3-7.2% of patients with giant cell arteritis (GCA), and intracranial vessels are rarely affected. We, herein, report a case of intracranial GCA with rapidly progressive multiple intracranial vascular lesions.
A 76-year-old woman visited a local doctor due to a headache; then, it improved spontaneously. Three months later, she suddenly had cerebral infarctions of bilateral pons and cerebellum. Magnetic resonance angiography (MRA) revealed the left internal carotid artery (ICA) occlusion, the right vertebral artery (VA) occlusion, and the left VA stenosis. She was diagnosed with atherothrombotic stroke and dual antiplatelet therapy was administered. However, 2 weeks later, the left VA stenosis was aggravated. Therefore, we reviewed the data of MRA performed 3 months ago and noted no lesions in the ICA and VA. T1 black-blood post-gadolinium imaging sequence magnetic resonance imaging (MRI) revealed vessel wall enhancement in the bilateral VA, left ICA, and bilateral superficial temporal artery. We performed a temporal artery biopsy and diagnosed her with GCA. The progression of the intracranial vascular lesions was decelerated by oral glucocorticoid administration.
Intracranial vascular lesions in GCA can be formed later than initial symptoms, such as headache, and aggravated despite improvement in headache. In patients with GCA, evaluating intracranial vessels as a control is useful for distinguishing them from arteriosclerotic lesions at the onset of CVA. Intracranial GCA is characterized by rapidly progressive vascular lesions in the bilateral ICA and VA. In addition, T1 black-blood post-gadolinium imaging sequence MRI may lead to early diagnosis and treatment.
巨细胞动脉炎（GCA）患者中缺血性脑血管意外（CVA）的发生率为3.3%-7.2%，颅内血管很少受累。在此，我们报告一例颅内GCA伴快速进展的多发性颅内血管病变的病例。
一名76岁女性因头痛就诊于当地医生处，随后头痛自行缓解。三个月后，她突然出现双侧脑桥和小脑脑梗死。磁共振血管造影（MRA）显示左侧颈内动脉（ICA）闭塞、右侧椎动脉（VA）闭塞以及左侧VA狭窄。她被诊断为动脉粥样硬化血栓形成性卒中并接受双联抗血小板治疗。然而，2周后，左侧VA狭窄加重。因此，我们回顾了3个月前进行的MRA数据，发现ICA和VA无病变。钆增强后T1黑血成像序列磁共振成像（MRI）显示双侧VA、左侧ICA和双侧颞浅动脉血管壁强化。我们进行了颞动脉活检，诊断她为GCA。口服糖皮质激素后颅内血管病变的进展减缓。
GCA的颅内血管病变可能在头痛等初始症状出现后才形成，且尽管头痛有所改善仍会加重。对于GCA患者，评估颅内血管作为对照有助于在CVA发病时将其与动脉硬化病变区分开来。颅内GCA的特征是双侧ICA和VA中血管病变快速进展。此外，钆增强后T1黑血成像序列MRI可能有助于早期诊断和治疗。
