Roaa S Alsolaimani1, Sankalp V Bhavsar1, Nader A Khalidi1, Christian Pagnoux1, Jennifer L Mandzia1, KengYeow Tay1, Lillian J Barra2. 1. 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. 2. 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.
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). CONCLUSION: 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.
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). CONCLUSION: 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.
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