title: Severe Intracranial Involvement in Giant Cell Arteritis: 5 Cases and Literature Review.
abstract: OBJECTIVE
  Involvement of intracranial arteries in giant cell arteritis (GCA) is rare. We describe the neurologic complications of intracranial GCA (IC GCA) and available treatment options.
  
  
  METHODS
  We describe 5 IC GCA cases from 3 Canadian vasculitis centers and review the literature. We searched English-language publications reporting similar patients meeting American College of Rheumatology (ACR) criteria for GCA and having intracranial artery involvement diagnosed by autopsy, magnetic resonance angiography, computed tomography angiography, or conventional angiography.
  
  
  RESULTS
  All 5 cases of IC GCA met ACR criteria for GCA; 4 cases had a temporal artery biopsy that was consistent with GCA. All cases experienced cerebrovascular accident(s). Arteritis involved the following vessels: intracranial internal carotid (n = 1), vertebrobasilar arteries (n = 1), or both (n = 3). All cases received aspirin and oral prednisone (preceded by intravenous methylprednisone in 3 cases), combined with an immunosuppressant in 4 cases. All patients survived; 2 had complete neurological recovery, 3 had residual neurologic sequelae. The literature review included 42 cases from 28 publications. The clinical features of the reported cases were similar to those of our 5 cases. However, mortality was 100% in untreated cases (n = 2), 58% in those treated with corticosteroid alone (n = 31), and 40% in those treated with corticosteroid and an immunosuppressant (n = 10).
  
  
  CONCLUSIONS
  IC GCA appears to be associated with neurologic complications and mortality. In some cases corticosteroid alone was not sufficient to prevent neurologic complications. The role of additional immunosuppressive agents needs further investigation.
authors.affiliation: From the Division of Rheumatology, Western University, London; Division of Rheumatology, McMaster University, Hamilton; Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto; Department of Clinical Neurological Sciences and Division of Radiology, Western University, London, Ontario, Canada; and Department of Medicine, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.R.S. Alsolaimani, MD, Division of Rheumatology, Western University, Department of Medicine, King Abdul-Aziz University Hospital; S.V. Bhavsar, MD; N.A. Khalidi, MD, FRCPC, FACP, FACR, Division of Rheumatology, McMaster University; C. Pagnoux, MBI, MPH, PhD, Division of Rheumatology, Mount Sinai Hospital, University of Toronto; J.L. Mandzia, MD, PhD, FRCPC, Department of Clinical Neurological Sciences, Western University; K.Y. Tay, MBBS, BSc(Med), FRCR, Division of Radiology, Western University; L.J. Barra, MD, MPH, FRCPC, Division of Rheumatology, Western University.
authors.forename: Roaa S
authors.initials: RS
authors.lastname: Alsolaimani
authors.affiliation: From the Division of Rheumatology, Western University, London; Division of Rheumatology, McMaster University, Hamilton; Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto; Department of Clinical Neurological Sciences and Division of Radiology, Western University, London, Ontario, Canada; and Department of Medicine, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.R.S. Alsolaimani, MD, Division of Rheumatology, Western University, Department of Medicine, King Abdul-Aziz University Hospital; S.V. Bhavsar, MD; N.A. Khalidi, MD, FRCPC, FACP, FACR, Division of Rheumatology, McMaster University; C. Pagnoux, MBI, MPH, PhD, Division of Rheumatology, Mount Sinai Hospital, University of Toronto; J.L. Mandzia, MD, PhD, FRCPC, Department of Clinical Neurological Sciences, Western University; K.Y. Tay, MBBS, BSc(Med), FRCR, Division of Radiology, Western University; L.J. Barra, MD, MPH, FRCPC, Division of Rheumatology, Western University.
authors.forename: Sankalp V
authors.initials: SV
authors.lastname: Bhavsar
authors.affiliation: From the Division of Rheumatology, Western University, London; Division of Rheumatology, McMaster University, Hamilton; Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto; Department of Clinical Neurological Sciences and Division of Radiology, Western University, London, Ontario, Canada; and Department of Medicine, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.R.S. Alsolaimani, MD, Division of Rheumatology, Western University, Department of Medicine, King Abdul-Aziz University Hospital; S.V. Bhavsar, MD; N.A. Khalidi, MD, FRCPC, FACP, FACR, Division of Rheumatology, McMaster University; C. Pagnoux, MBI, MPH, PhD, Division of Rheumatology, Mount Sinai Hospital, University of Toronto; J.L. Mandzia, MD, PhD, FRCPC, Department of Clinical Neurological Sciences, Western University; K.Y. Tay, MBBS, BSc(Med), FRCR, Division of Radiology, Western University; L.J. Barra, MD, MPH, FRCPC, Division of Rheumatology, Western University.
authors.forename: Nader A
authors.initials: NA
authors.lastname: Khalidi
authors.affiliation: From the Division of Rheumatology, Western University, London; Division of Rheumatology, McMaster University, Hamilton; Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto; Department of Clinical Neurological Sciences and Division of Radiology, Western University, London, Ontario, Canada; and Department of Medicine, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.R.S. Alsolaimani, MD, Division of Rheumatology, Western University, Department of Medicine, King Abdul-Aziz University Hospital; S.V. Bhavsar, MD; N.A. Khalidi, MD, FRCPC, FACP, FACR, Division of Rheumatology, McMaster University; C. Pagnoux, MBI, MPH, PhD, Division of Rheumatology, Mount Sinai Hospital, University of Toronto; J.L. Mandzia, MD, PhD, FRCPC, Department of Clinical Neurological Sciences, Western University; K.Y. Tay, MBBS, BSc(Med), FRCR, Division of Radiology, Western University; L.J. Barra, MD, MPH, FRCPC, Division of Rheumatology, Western University.
authors.forename: Christian
authors.initials: C
authors.lastname: Pagnoux
authors.affiliation: From the Division of Rheumatology, Western University, London; Division of Rheumatology, McMaster University, Hamilton; Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto; Department of Clinical Neurological Sciences and Division of Radiology, Western University, London, Ontario, Canada; and Department of Medicine, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.R.S. Alsolaimani, MD, Division of Rheumatology, Western University, Department of Medicine, King Abdul-Aziz University Hospital; S.V. Bhavsar, MD; N.A. Khalidi, MD, FRCPC, FACP, FACR, Division of Rheumatology, McMaster University; C. Pagnoux, MBI, MPH, PhD, Division of Rheumatology, Mount Sinai Hospital, University of Toronto; J.L. Mandzia, MD, PhD, FRCPC, Department of Clinical Neurological Sciences, Western University; K.Y. Tay, MBBS, BSc(Med), FRCR, Division of Radiology, Western University; L.J. Barra, MD, MPH, FRCPC, Division of Rheumatology, Western University.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Mandzia
authors.affiliation: From the Division of Rheumatology, Western University, London; Division of Rheumatology, McMaster University, Hamilton; Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto; Department of Clinical Neurological Sciences and Division of Radiology, Western University, London, Ontario, Canada; and Department of Medicine, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.R.S. Alsolaimani, MD, Division of Rheumatology, Western University, Department of Medicine, King Abdul-Aziz University Hospital; S.V. Bhavsar, MD; N.A. Khalidi, MD, FRCPC, FACP, FACR, Division of Rheumatology, McMaster University; C. Pagnoux, MBI, MPH, PhD, Division of Rheumatology, Mount Sinai Hospital, University of Toronto; J.L. Mandzia, MD, PhD, FRCPC, Department of Clinical Neurological Sciences, Western University; K.Y. Tay, MBBS, BSc(Med), FRCR, Division of Radiology, Western University; L.J. Barra, MD, MPH, FRCPC, Division of Rheumatology, Western University.
authors.forename: KengYeow
authors.initials: K
authors.lastname: Tay
authors.affiliation: From the Division of Rheumatology, Western University, London; Division of Rheumatology, McMaster University, Hamilton; Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto; Department of Clinical Neurological Sciences and Division of Radiology, Western University, London, Ontario, Canada; and Department of Medicine, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.R.S. Alsolaimani, MD, Division of Rheumatology, Western University, Department of Medicine, King Abdul-Aziz University Hospital; S.V. Bhavsar, MD; N.A. Khalidi, MD, FRCPC, FACP, FACR, Division of Rheumatology, McMaster University; C. Pagnoux, MBI, MPH, PhD, Division of Rheumatology, Mount Sinai Hospital, University of Toronto; J.L. Mandzia, MD, PhD, FRCPC, Department of Clinical Neurological Sciences, Western University; K.Y. Tay, MBBS, BSc(Med), FRCR, Division of Radiology, Western University; L.J. Barra, MD, MPH, FRCPC, Division of Rheumatology, Western University. lbarra2@uwo.ca.
authors.forename: Lillian J
authors.initials: LJ
authors.lastname: Barra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*
keywords: CRANIAL ARTERY; GIANT CELL ARTERITIS; STROKE