Unilateral Complete Ophthalmoplegia and Ptosis as Primary Presentation of Giant Cell Arteritis: A Case Report

A 79-year-old woman presented with a one-week history of left ptosis and diplopia. These symptoms were preceded by an evolving headache, jaw claudication and one episode of transient loss of vision, all of which had resolved by the time of presentation. Examination revealed unilateral complete ophthalmoplegia, ptosis and a minimally reactive pupil. The right eye was unaffected and visual acuity was normal bilaterally. Raised inflammatory markers and positive ultrasound doppler of temporal arteries confirmed the diagnosis of giant cell arteritis (GCA). The patient responded well to oral corticosteroid therapy, showing near resolution of symptoms during 3-week follow-up. Complete ophthalmoplegia and ptosis secondary to multiple cranial nerve (CN) palsies, with sparing of vision, is a rare presentation of GCA as per the literature. In reported cases of CN palsies in GCA, there is often some degree of accompanying visual impairment and rarely are multiple CNs affected. Such a presentation holds a better prognosis as visual loss in this setting is often permanent whereas ocular CN palsies respond well to corticosteroid therapy.