Two cases of recurrent stroke in treated giant cell arteritis: diagnostic and therapeutic dilemmas.
It is not established whether the increased risk of stroke in patients with giant cell arteritis (GCA) is because of atherosclerosis, persistent arterial inflammation, or an iatrogenic effect of corticosteroids. This creates difficulties in choosing the most appropriate treatment. We report 2 patients with GCA who developed repeated strokes involving different arterial territories following initiation of corticosteroid therapy, despite resolution of cranial symptoms and normalization of inflammatory markers. Subsequent investigation suggested persisting arteritis as the cause of these strokes. The cases revealed the limitations of laboratory tests or imaging techniques in determining the cause of stroke in recently diagnosed GCA. There is a need to develop effective means of monitoring GCA activity and to determine the most effective treatment approach in this circumstance.
Fitzgerald
Alasdair J
AJ
Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, Scotland. alasdair.fitzgerald@nhs.net
Ironside
James W
JW
Summers
David M
DM
Dennis
Martin S
MS
McRorie
Euan R
ER
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D013699:Temporal Arteries / Q000473:pathology
D000305:Adrenal Cortex Hormones; D011239:Prednisolone