title: Giant cell arteritis causing symmetric bilateral posterior circulation infarcts.
abstract: An 82-year-old woman presented with bilateral, symmetric posterior circulation infarctions secondary to giant cell arteritis (GCA). Her atypical clinical presentation included a lack of headache and fever, but she exhibited signs of systemic illness including generalized weakness, cachexia, apathy, and anemia. Laboratory testing revealed a markedly elevated erythrocyte sedimentation rate, but only a borderline elevated C-reactive protein. Head and neck vascular imaging demonstrated a pattern of vertebral arterial narrowing consistent with GCA-a diagnosis confirmed by temporal artery biopsy. Her unusual symptomatic, laboratory, and imaging presentation highlights the importance of considering GCA in the differential diagnosis of unusual bilateral stroke syndromes, where early treatment decreases morbid outcomes.
authors.affiliation: From the Departments of *Neurology and †Pathology, Massachusetts General Hospital; and ‡Harvard Medical School, Boston, MA.
authors.forename: Devin D
authors.initials: DD
authors.lastname: Mackay
authors.forename: Graham R
authors.initials: GR
authors.lastname: Huesmann
authors.forename: Roseann I
authors.initials: RI
authors.lastname: Wu
authors.forename: James R
authors.initials: JR
authors.lastname: Stone
authors.forename: Misha L
authors.initials: ML
authors.lastname: Pless
mesh_terms: D000369:Aged, 80 and over; D001706:Biopsy; D020520:Brain Infarction / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D013699:Temporal Arteries / Q000473:pathology
chemical_list: D002097:C-Reactive Protein