title: Multiple cranial nerve palsies in giant cell arteritis and response to cyclophosphamide: a case report and review of the literature.
abstract: Giant cell arteritis (GCA) has been previously associated with cranial mononeuritis (usually optic neuritis). We hereby describe a 68-year-old man who presented due to fever and diplopia of acute onset. Physical examination revealed left abducens nerve palsy and a hearing defect in the right ear. Brain imaging and cerebrospinal fluid analysis were not diagnostic. GCA was suspected, and treatment with high-dose methylprednisolone was initiated, leading to marked improvement. Temporal artery biopsy confirmed the presence of GCA. While considering corticosteroid tapering, the patient experienced hoarseness due to right laryngeal nerve palsy. Addition of cyclophosphamide to the treatment resulted in full response. GCA mainly affects large vessels, but one or more cranial nerve palsies may also occur. Following a review of the literature, this is the first report of three cranial nerve palsies in the setting of histologically proven GCA. The role of cyclophosphamide in this entity is also discussed.
authors.affiliation: First Department of Propaedeutic Internal Medicine, Laiko General Hospital, 17, Agiou Thoma Street, 11527, Goudi, Athens, Greece, christinafytili@gmail.com.
authors.forename: Christina
authors.initials: C
authors.lastname: Fytili
authors.forename: Vassiliki Kalliopi
authors.initials: VK
authors.lastname: Bournia
authors.forename: Chryssa
authors.initials: C
authors.lastname: Korkou
authors.forename: Georgios
authors.initials: G
authors.lastname: Pentazos
authors.forename: Alexander
authors.initials: A
authors.lastname: Kokkinos
mesh_terms: D000368:Aged; D003389:Cranial Nerve Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D003520:Cyclophosphamide / Q000627:therapeutic use*; D013700:Giant Cell Arteritis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide