| Lethal giant cell arteritis with multiple ischemic strokes despite aggressive immunosuppressive therapy. | |
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MedLine Citation:
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PMID: 20609853 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Two patients with giant cell arteritis (GCA) had a malignant course despite aggressive immunosuppressive therapy. A 63-year-old woman presented with symptoms of headache, jaw claudication, scalp paresthesia, and visual disturbances. A temporal artery biopsy showed GCA. While on prednisone, she suffered ischemic strokes, and serial cerebral angiograms demonstrated bilateral, severe and progressive narrowing of distal vertebral and internal carotid arteries. Despite escalating immunosuppressive therapies, she suffered more infarcts and eventually died. Postmortem examination of arteries showed no active inflammation. A 65-year-old man presented with extrapyramidal symptoms though no symptoms typical of GCA. Imaging showed multiple ischemic strokes. Because serial angiograms demonstrated findings similar to the first patient, he underwent temporal artery biopsy that showed GCA. He died 7 months after his presentation with complications of aggressive immunosuppressive therapy. These two patients confirm that GCA can follow a lethal course despite escalating immunosuppressive therapies. Our two patients were unique in that eventually both anterior and posterior circulations were involved bilaterally in a characteristic location where the arteries penetrate the dura. This pattern should always raise the possibility of GCA and, if confirmed, should prompt aggressive immunosuppressive therapy. The dismal outcomes despite this approach may suggest a non-inflammatory arteriopathy, as seen on necropsy in one of our patients. Such an arteriopathy may require novel therapies to be considered for this severe variant of GCA. |
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Authors:
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Christine Lu-Emerson; Melanie Walker; Bertrand R Huber; Basavaraj Ghodke; W T Longstreth; Sandeep P Khot |
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Publication Detail:
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Type: Case Reports; Journal Article Date: 2010-06-17 |
Journal Detail:
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Title: Journal of the neurological sciences Volume: 295 ISSN: 1878-5883 ISO Abbreviation: J. Neurol. Sci. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-08 Completed Date: 2011-01-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0375403 Medline TA: J Neurol Sci Country: Netherlands |
Other Details:
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Languages: eng Pagination: 120-4 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2010 Elsevier B.V. All rights reserved. |
Affiliation:
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Department of Neurology, University of Washington, Seattle, WA 98104, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Brain Infarction / etiology Cerebral Angiography Disease Progression Female Giant Cell Arteritis* / complications, immunology, therapy Humans Immunosuppression / methods* Magnetic Resonance Imaging / methods Male Middle Aged Stroke* / complications, immunology, therapy |
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