Complicated aortic arch syndrome and ischemic optic neuropathy presenting as giant cell (temporal) arteritis

An acute loss of vision accompanied by signs of optic nerve head ischemia in an elderly patient should alert the examiner to suspect the presence of temporal arteritis until it can be proven otherwise. The patient presented here had ischemic optic neuropathy that was initially thought to be due to temporal arteritis, but eventually was proven to be associated with pronounced atherosclerotic aortic arch disease. The diagnosis was complicated by the severe loss of vision and by an elevated erythrocyte sedimentation rate (ESR). A temporal artery biopsy was normal, and other findings implicated the pronounced diffuse atherosclerosis as the cause of the ischemia of the optic nerve head. Therapy was directed toward the vascular occlusive disease, and involved an aortoinnominate bypass graft.