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Internuclear ophthalmoplegia in giant cell arteritis
G T Thomson1, J L Johnston, J A Sharpe
1Division of Rheumatology, Toronto Hospital, ON, Canada.
The Journal of Rheumatology
|May 1, 1989
Summary
Giant cell arteritis (GCA) can cause brainstem ischemia, leading to internuclear ophthalmoplegia. This study describes two GCA cases with this rare complication, potentially linked to rapid steroid tapering.
Area of Science:
- Neurology
- Ophthalmology
- Rheumatology
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis that can affect cranial nerves and lead to ophthalmoplegia.
- Brainstem ischemia is a recognized complication of GCA, but internuclear ophthalmoplegia has not been previously reported.
Observation:
- This report details two patients with biopsy-proven GCA who developed internuclear ophthalmoplegia.
- The ophthalmoplegia in both cases was attributed to brainstem ischemia.
Findings:
- Internuclear ophthalmoplegia in GCA may result from embolization due to thrombosed vertebral arteries or arteritis affecting brainstem perforating vessels.
- A rapid reduction in steroid dosage was temporally associated with the onset of brainstem infarction in both described cases.
Implications:
- This finding expands the spectrum of neurological complications associated with GCA.
- Clinicians should consider brainstem ischemia and internuclear ophthalmoplegia in GCA patients, particularly following rapid steroid withdrawal.
- Further research is warranted to elucidate the mechanisms and optimal management of this rare GCA manifestation.