[Giant cell arteritis revealed by bilateral internuclear ophthalmoplegia]

We report an original observation of giant cell arteritis (GCA) revealed by bilateral internuclear ophthalmoplegia due to parenchymal inflammatory involvement of the central nervous system.

An 84-year-old female patient presented to our emergency department because of diplopia due to bilateral internuclear ophthalmoplegia. Cerebral MRI found a T2 hypersignal with enhancement after gadolinium injection in T1 sequence of the two medial longitudinal fascicles. Lumbar puncture was negative, biology only found elevated acute phase response proteins, PET scan showed large vessel vasculitis and temporal artery biopsy revealed GCA. Treatment with corticosteroids and methotrexate led to normalization of clinical, radiological and biological abnormalities during follow-up.

Bilateral internuclear ophthalmoplegia due to parenchymal inflammatory involvement of the central nervous system may be an ocular manifestation of GCA.