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Menière's syndrome: an atypical presentation of giant cell arteritis (temporal arteritis)
K X McKennan1, S L Nielsen, C Watson
1Sacramento Ear, Nose and Throat Surgical and Medical Group, Inc., CA.
Insights
Giant cell arteritis (GCA) can cause sudden hearing and balance problems in older adults. Prompt diagnosis and treatment are crucial, as GCA can lead to fatal brainstem strokes.
Area of Science:
- Neurology
- Rheumatology
- Otolaryngology
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium-sized arteries.
- Cranial involvement in GCA can lead to serious neurological and vascular complications.
- Audio-vestibular symptoms are not commonly recognized as early indicators of GCA.
Purpose of the Study:
- To highlight the association between giant cell arteritis and severe audio-vestibular dysfunction.
- To emphasize the potential for GCA to cause fatal vertebral artery involvement.
- To underscore the importance of early GCA diagnosis in elderly patients with acute audio-vestibular symptoms.
Main Methods:
- Case report of three patients with biopsy-proven giant cell arteritis.
- Detailed description of clinical presentations, including audio-vestibular symptoms.
- Inclusion of postmortem findings in fatal cases.
Main Results:
- All three patients presented with significant auditory and vestibular symptoms.
- Two patients experienced fatal brainstem infarction due to GCA affecting the vertebral arteries.
- Postmortem examination confirmed GCA as the cause of vertebral artery pathology.
Conclusions:
- Acute onset audio-vestibular symptoms in elderly patients warrant a high suspicion for giant cell arteritis.
- GCA-related vertebral artery inflammation can lead to devastating neurological outcomes, including brainstem infarction.
- Urgent high-dose corticosteroid treatment and specialist consultation are critical for managing GCA presenting with these symptoms.
Abstract:
The authors discuss three patients with biopsy-proven giant cell arteritis (GCA) who experienced significant auditory and vestibular symptoms. Two of the patients who presented with audiovestibular symptomatology died as a direct result of GCA affecting the vertebral arteries. Postmortem findings are reported. This report illustrates the importance of maintaining a high index of suspicion of GCA in elderly patients who present with the acute onset of audio-vestibular symptoms. These symptoms can be a herald of brain stem infarction if giant cell arteritis is the underlying cause. High-dose prednisone and rheumatologic/neurologic consultation is required.