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Related Experiment Videos

Refractory giant cell arteritis with spinal cord infarction

S L Galetta1, L J Balcer, A P Lieberman

  • 1Department of Neurology, University of Pennsylvania Medical Center, Philadelphia 19104, USA.

Neurology
|December 31, 1997
PubMed
Summary

Giant cell arteritis can cause rare spinal cord infarction, even during treatment. This case highlights necrotizing arteritis in spinal arteries leading to myelopathy and vision loss.

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Area of Science:

  • Neurology
  • Rheumatology
  • Vascular Medicine

Background:

  • Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium arteries.
  • Steroid-refractory GCA presents a therapeutic challenge, necessitating alternative treatment strategies.
  • Neurological complications in GCA are recognized but spinal cord involvement is exceptionally rare.

Observation:

  • An elderly patient with aggressive, steroid-refractory GCA developed myelopathy and bilateral visual loss.
  • Clinical presentation suggested central nervous system involvement despite ongoing GCA treatment.
  • Pathological examination revealed spinal cord infarction.

Findings:

  • The spinal cord infarction was attributed to extensive necrotizing granulomatous arteritis affecting the spinal arteries.

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  • Vasculitic changes in spinal arteries were confirmed as the cause of infarction.
  • This contrasts with a previous report where spinal artery vasculitis was not identified in GCA-associated spinal cord infarction.

    • Implications:

    • This case underscores the potential for GCA to cause severe spinal cord ischemia, even in treated patients.
    • Highlights the importance of considering GCA in the differential diagnosis of myelopathy, particularly in older adults.
    • Suggests that detailed pathological examination of spinal arteries is crucial for understanding GCA pathogenesis and complications.