Description

A 78-year-old man with a history of atrial fibrillation and hypertension was admitted to the hospital for a mild left hemispheric stroke. He reported having jaw claudication, frontotemporal headache and malaise for the past several months. MRI angiography of the brain revealed occlusion of both vertebral arteries and significant stenosis of the left supraclinoidal internal carotid artery (ICA) (figure 1A, C). The vessel wall of the aortic arch, and origin of the vertebral arteries and left ICA were enhanced after gadolinium injection (figure 1B), suggesting the presence of vasculitis, in this case giant cell arteritis (GCA) confirmed by temporal biopsy. The patient was treated with prednisone 1 mg/kg for 10 days and then a given descending dose, with consequent clinical status and ICA stenosis improvement (figure 1D).

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Figure 1

(A) Left internal carotid artery (ICA) stenosis and vertebral artery occlusion. (B) ICA wall enhanced after gadolinium injection. (C) Left ICA before steroid treatment. (D) Left ICA after steroid treatment.

GCA presenting as multiple large vessel stenosis is a rare and often underdiagnosed disease,1 and radiological findings of MRI may suggest the diagnosis.2 Despite treatment, vascular stenosis is rarely resolved. In case of early diagnosis and treatment, the involvement of large vessels in GCA can be partially resolved.3