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Viral Meningitis01:18

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Viral meningitis is the most common form of meningitis and is often referred to as aseptic meningitis to indicate the absence of bacterial involvement. It is generally milder than bacterial meningitis, with symptoms including fever, headache, stiff neck, drowsiness, nausea, photophobia, and vomiting. Rarely, more severe manifestations or death may occur. Common causative agents include enteroviruses, particularly coxsackie A and B viruses and echoviruses, all members of the Enterovirus genus...
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[Brain stem infarction, temporal headache, and elevated inflammatory parameters in a 74-year-old man].

M Gehlen1,2, M Schwarz-Eywill3, N Schäfer3

  • 1Abteilung für Rheumatologie und Osteologie, Klinik Der Fürstenhof, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland. gehlen@staatsbad-pyrmont.de.

Der Internist
|April 9, 2016
PubMed
Summary

Giant cell arteritis, a rare cause of brain stem infarction, can affect vertebral arteries. This case highlights a steroid-refractory course, leading to multiple brain infarcts despite treatment.

Keywords:
Duplex sonographyMedulla oblongataPrednisoloneSteroid-refractory giant cell arteritisVertebral artery

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Area of Science:

  • Neurology
  • Rheumatology
  • Vascular Medicine

Background:

  • Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium-sized arteries.
  • Cranial involvement is common, but vertebral artery involvement is considered rare.
  • Elevated inflammatory markers, such as C-reactive protein and erythrocyte sedimentation rate, are typical indicators.

Observation:

  • A 74-year-old man presented with brain stem infarction, temporal headache, and elevated inflammatory parameters.
  • Histology, duplex sonography, and MRI confirmed GCA involving temporal and vertebral arteries.
  • The patient experienced two additional brain infarcts within six months despite intensive immunosuppressive therapy.

Findings:

  • Vertebral artery involvement in GCA is uncommon.
  • Steroid-refractory GCA, particularly with vertebral artery involvement, is exceptionally rare.
  • Brain stem infarction can be a direct consequence of GCA affecting the vertebral artery.

Implications:

  • This case underscores the potential for GCA to cause severe neurological deficits, including brain stem infarction.
  • It highlights the possibility of steroid-refractory disease courses in GCA, necessitating alternative therapeutic strategies.
  • Early recognition and aggressive management are crucial for patients with GCA and vertebral artery involvement to prevent devastating neurological outcomes.