Markers of Giant Cell Arteritis in Patients Presenting With Ischemic Stroke: A Scoping Review

In patients with giant cell arteritis (GCA), 2.8%-8.2% present with ischemic stroke (IS) or transient ischemic attack (TIA). GCA diagnosis may be overlooked, and immunosuppressive treatment delayed if typical symptoms are absent or if a common cause of IS coexists. This study aimed to identify potential markers of GCA through clinical evaluation and baseline investigation of IS/TIA patients.

Two authors independently conducted a scoping review using MEDLINE and EMBASE databases to identify patients diagnosed with GCA after presenting with IS/TIA. All articles, including the gray literature, were considered from January 2000 onwards if individualized data were described. Only cases of IS/TIA with GCA later diagnosed as the etiology were included for analysis.

A total of 101 publications were included, pooling data on 141 patients for analysis. The mean age was 73.6 years, and 61 were women. Patients experienced either single (56.0%) or multiple IS/TIA events (44.0%). Associated symptoms included GCA-related pain, such as headaches (50.4%), constitutional symptoms (47.5%), and temporal artery inflammation (27.0%). Neurological deficits involved corticospinal tracts (41.8%), and cerebellar functions (53.2%). Most patients had clinical or radiological evidence of vertebrobasilar involvement (83.7%). Multifocal involvement of the vertebrobasilar and carotid territories was supported when combining clinical-radiological manifestations (41.1%). Recurrent events were common (44.0%).

GCA should be considered in IS/TIA patients aged ≥ 50 years with vertebrobasilar or multiterritorial involvement, or recurrent IS/TIA despite secondary prevention.