[Reversibility of vertebrobasilar stenoses following treatment with corticosteroid therapy in patients with giant cell arteritis].
BACKGROUND
Involvement of intracranial arteries in giant cell arteritis is a rare condition but often carries a fatal prognosis. Corticosteroids seem to be insufficient to avoid ischemic cerebral complications, and could even promote the occurrence of stroke. We report the case of a patient with giant cell arteritis who experienced recurrent cerebellar stroke caused by intracranial vertebrobasilar stenoses with a favorable outcome following treatment.


METHODS
A 77-year-old woman presented with a 3-month history of impaired general condition. She had new-onset headaches, jaw claudication and transient vertigo, especially when she woke-up. The brain MRI showed a recent cerebellar infarction. One week later, she was hospitalized for a clinical deterioration related to a recurrent cerebellar stroke caused by intracranial vertebro-basilar stenoses. Giant cell arteritis was confirmed on the temporal artery biopsy. A treatment with high-dose oral corticosteroids was begun associated with an intensive antiplatelet therapy. The clinical outcome was favorable with rapid improvement of gait imbalance together with a complete radiological regression of the intracranial stenoses.


CONCLUSIONS
Ischemic stroke in giant cell intracranial arteritis is a severe condition without a well-defined treatment. Corticosteroid therapy improves intracranial stenoses caused by vasculitis but should be initially associated with an intensive antithrombotic therapy to avoid early recurrence of cerebral infarcts.
Polomat
K
K
Service de neurologie, CHU de Fort-de-France, 97200 La Meynard, Fort-de-France, Martinique.
Chausson
N
N
Olindo
S
S
Smadja
D
D
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D001488:Basilar Artery / Q000473:pathology; D001921:Brain / Q000473:pathology; D002526:Cerebellar Diseases / Q000150:complications / Q000473:pathology; D002531:Cerebellum / Q000473:pathology; D003251:Constriction, Pathologic / Q000150:complications / Q000188:drug therapy; D005260:Female; D020233:Gait Disorders, Neurologic / Q000188:drug therapy / Q000209:etiology; D013700:Giant Cell Arteritis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020521:Stroke / Q000209:etiology; D014711:Vertebral Artery / Q000473:pathology; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000209:etiology* / Q000473:pathology
D000305:Adrenal Cortex Hormones; D010975:Platelet Aggregation Inhibitors