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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
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.
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.
