Ocular muscle paresis and cranial arteritis--an unusual case

A 72-year-old woman had biopsy-proven cranial arteritis together with previously unreported findings of fluctuating mild ocular muscle paresis which had continued over the course of 4 1/3 years despite treatment with systemic corticosteroids. There was no optic nerve or central retinal artery involvement. This patient is unique in that muscle paresis is usually transient, lasting several days to a few weeks rather than 4 1/3 years. Response to steroids is usually prompt, and optic nerve or central retinal artery involvement is often associated. Therefore, we stress the importance of considering cranial arteritis in all patients over 55 years old who have transient or persistent diplopia, since immediate treatment may prevent optic nerve or central retinal artery involvement, which often follows within a few days.