How the ultrasound protocol may improve the timely diagnosis of cerebrovascular complications in giant cell arteritis.

Giant cell arteritis (GCA) is a granulomatous inflammatory vasculitis of medium and large vessels, with a predilection for the external carotid and ophthalmic arteries and, to a lesser extent, for the vertebral arteries. In early phases of the disease, symptoms may be nonspecific, such as malaise, fever, and weight loss. Overt typical GCA symptoms are temporal headache, scalp tenderness, jaw claudication, and sudden vision loss. Inflammatory vessel involvement in GCA results in partial or complete occlusion of the arterial lumen, leading to complications such as acute ischemic optic neuropathy, transient ischemic attack, and ischemic stroke. The latter is a rare but severe complication of GCA, and it has been reported in 2.8-7% of patients diagnosed with GCA. The majority of ischemic strokes are related to inflammation of vertebral and, less frequently, basilar and internal carotid arteries. Stroke in GCA patients affects vertebrobasilar circulation in 50 to 100% of cases, compared to only 20% observed in cerebrovascular accidents in the general population. Prompt diagnosis of GCA cranial involvement is pivotal, since early start of high-dose corticosteroid treatment and/or immunosuppressive drugs (e.g., tocilizumab and methotrexate) is highly effective in preventing further evolution and recurrence of such complications. In this viewpoint, we have briefly pinpointed the current possible value of vertebral ultrasound from both the rheumatologist's and neurologist's point of view.