Giant cell arteritis. Episodes of syncope add complexity to an unusual presentation

GCA presents in various forms, creating a diagnostic conundrum for the treating physician. Evaluation requires extensive medical examination, testing, and imaging to rule out other conditions. Compared with the process of diagnosing GCA, treating it is relatively straightforward. Most patients show significant improvement with corticosteroid therapy. Our patient presented with syncope, which also has numerous causes. Detailed testing confirmed a positional trigger for her syncope in the absence of hemodynamic disturbances. She responded promptly to corticosteroid therapy. We speculate that flow-limiting stenosis in the vertebrobasilar system may have caused her symptoms.