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Updated: May 7, 2026
06:35
An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Giant cell arteritis causing symmetric bilateral posterior circulation infarcts.
Devin D Mackay1, Graham R Huesmann, Roseann I Wu
1From the Departments of *Neurology and †Pathology, Massachusetts General Hospital; and ‡Harvard Medical School, Boston, MA.
Summary
Giant cell arteritis (GCA) can cause bilateral strokes even without typical symptoms like headache. Early diagnosis and treatment of GCA are crucial for preventing severe outcomes in stroke patients.
Area of Science:
- Neurology
- Rheumatology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium arteries.
- Posterior circulation strokes can have diverse etiologies, necessitating a broad differential diagnosis.
Observation:
- An 82-year-old woman presented with bilateral, symmetric posterior circulation infarctions.
- She lacked typical GCA symptoms (headache, fever) but showed systemic signs (weakness, cachexia, anemia).
- Elevated erythrocyte sedimentation rate (ESR) was noted, with borderline C-reactive protein (CRP).
Findings:
- Vascular imaging revealed vertebral arterial narrowing consistent with GCA.
- Temporal artery biopsy confirmed the diagnosis of giant cell arteritis.
- The patient's presentation was atypical for GCA, complicating initial diagnosis.
Implications:
- This case underscores the importance of considering GCA in atypical bilateral stroke syndromes.
- Prompt diagnosis and initiation of GCA treatment can mitigate severe neurological morbidity.
- Highlights the need for comprehensive evaluation in elderly patients with unexplained stroke and systemic symptoms.
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