Bilateral carotid siphon involvement in giant cell arteritis

Area of Science:

• Ophthalmology
• Neurology
• Vascular Surgery

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis that can affect large and medium-sized arteries.
• Ocular involvement in GCA, such as ischemic optic neuropathy, can lead to irreversible vision loss.
• Bruits, particularly orbital and carotid, can be indicative of underlying vascular pathology.

Purpose of the Study:

• To report a case of ischemic optic neuropathy in a patient with giant cell arteritis.
• To investigate the association between GCA, orbital/carotid bruits, and vascular changes.
• To evaluate the efficacy of high-dose steroid treatment in managing GCA-related symptoms and findings.

Main Methods:

• Case presentation of a 60-year-old woman with giant cell arteritis.
• Clinical examination including auscultation for bruits.
• Cerebral angiography to assess internal carotid arteries.
• Treatment with high-dose corticosteroids.

Main Results:

• The patient presented with acute unilateral ischemic optic neuropathy and bilateral carotid artery and orbital bruits.
• Angiography revealed vascular changes consistent with arteritis in the cavernous and petrous segments of both internal carotid arteries.
• Following high-dose steroid therapy, the bruits resolved.

Conclusions:

• This case highlights a potential link between giant cell arteritis, ischemic optic neuropathy, and the presence of carotid and orbital bruits.
• High-dose steroid treatment appears effective in resolving these clinical and angiographic findings in GCA.
• Early diagnosis and management of GCA are crucial to prevent vision-threatening complications.