Giant Cell Arteritis Presenting as Recurrent Left Middle Cerebral Artery Territory Infarction

Giant cell arteritis (GCA) is the most common systemic vasculitis in older adults and may rarely present with cerebrovascular ischaemic events. We report a case of a woman in her 70s who developed recurrent left middle cerebral artery territory infarctions despite dual antiplatelet therapy. Following the recurrent stroke, further assessment revealed a history of temporal pain, scalp tenderness, headache, transient visual disturbance, and jaw discomfort, with markedly elevated inflammatory markers. Temporal and axillary artery ultrasonography performed after initiation of corticosteroid therapy was normal. Despite negative imaging findings, the overall clinical presentation was considered consistent with GCA-associated stroke. Treatment with high-dose corticosteroids resulted in complete resolution of cranial symptoms and no further cerebrovascular events. This case highlights the importance of considering GCA in older patients presenting with recurrent ischaemic stroke, particularly when accompanied by cranial symptoms and unexplained systemic inflammation. It also demonstrates that anterior circulation infarction may occur in GCA and that negative vascular ultrasonography does not exclude the diagnosis when clinical suspicion remains high.