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Related Experiment Video

Updated: Jan 22, 2026

An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis

Published on: February 8, 2019

Recurrent Stroke in Giant Cell Arteritis Despite Immunotherapy.

Benjamin C Cox¹, Jimmy R Fulgham, James P Klaas

¹Department of Neurology, Mayo Clinic, Rochester, MN.

The Neurologist

|June 28, 2019

Summary

Giant cell arteritis (GCA) can cause rare but severe strokes, even with steroid treatment. Aggressive immunosuppression is crucial for managing these dangerous cerebrovascular complications.

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Area of Science:

Neurology
Rheumatology
Vascular Medicine

Background:

Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting medium and large arteries.
Cerebrovascular complications, though rare, represent a significant cause of morbidity and mortality in GCA patients.

Observation:

A 59-year-old male with GCA presented with lower extremity vasculitis, followed by multiple strokes despite corticosteroid therapy.
Angiography revealed stenosis at the dural entry points of bilateral carotid and vertebral arteries.
Disease progression and additional strokes occurred even after initiating cyclophosphamide and later switching to tocilizumab.

Findings:

GCA can manifest with cerebrovascular events, particularly affecting vessels at the dura mater's entry point.
Corticosteroids alone may be insufficient to prevent stroke progression in some GCA cases.
Aggressive immunosuppressive therapy escalation is necessary, but outcomes remain poor in severe cases.

Implications:

This case underscores the importance of recognizing and promptly treating cerebrovascular complications in GCA.
Early escalation of immunosuppressive therapy may be critical for improving outcomes.
The predilection for dural entry vessels highlights a specific vulnerability in GCA-related stroke.