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Stroke and temporal arteritis: A study of 6 cases
A Lago1, J I Tembl1, G Fortea1
1Servicio de Neurología, Hospital Universitario La Fe, Valencia, España.
Insights
Ischaemic stroke due to temporal arteritis (giant cell arteritis) is serious and requires high suspicion for early diagnosis and treatment. New imaging techniques aid assessment, and endovascular therapy may benefit selected patients.
Area of Science:
- Neurology
- Rheumatology
- Vascular Medicine
Background:
- Ischaemic stroke secondary to temporal arteritis (giant cell arteritis) presents diagnostic and management challenges.
- A high index of suspicion is crucial for timely intervention.
Observation:
- A series of 6 patients with biopsy-proven temporal arteritis and ischaemic stroke were analyzed.
- Patients had a mean age of 68.3 years, with 50% being female and presenting with systemic symptoms.
- Both anterior and posterior circulation were affected, with MRI angiography, Doppler sonography, and PET-CT proving useful.
Findings:
- Clinical outcomes were poor, with 33% scoring ≥3 on the modified Rankin scale (including one death).
- Recurrent strokes occurred in two patients despite high-dose corticosteroids; two patients underwent angioplasty.
- Mean follow-up was 26 months.
Implications:
- Early corticosteroid treatment is vital for managing stroke in giant cell arteritis.
- Advanced diagnostic techniques improve patient assessment and treatment selection.
- Endovascular treatment is a potential therapeutic option for specific cases.
Introduction:
Though uncommon, ischaemic stroke due to temporal arteritis carries serious difficulties for diagnosis and subsequent management and requires a high level of suspicion.
Methods:
We analysed a series of 6 patients with biopsy-proven temporal arteritis presenting with ischaemic stroke. We discuss clinical characteristics, difficulties of assessment, short- and long-term progression, treatment, and the usefulness of new diagnostic techniques.
Results:
Our sample of 6 patients had a mean age of 68.3 years; 50% were women. The majority of patients showed systemic symptoms. Anterior and posterior circulation were affected similarly. MRI angiography, Doppler sonography, and PET-CT proved to be very useful for diagnosis and treatment. Mean follow-up time was 26 months. Clinical outcomes were far from good: 33% scored≥3 on the modified Rankin scale, including one death. Two patients had recurrent stroke despite treatment with full doses of corticosteroids, and 2 underwent angioplasty.
Conclusions:
Stroke caused by giant cell arteritis is a serious and potentially severe condition which requires a high level of suspicion and early treatment with corticosteroids. New diagnostic techniques contribute to refining patient assessment and identifying the optimal treatment. Endovascular treatment may be a valid therapeutic option in selected patients.
