Abstract
Giant cell arteritis (GCA) may affect the brain-supplying arteries, resulting in ischemic stroke, whereby the vertebrobasilar territory is most often involved. Since etiology is unknown in 25% of stroke patients and GCA is hardly considered as a cause, we examined in a pilot study, whether screening for GCA after vertebrobasilar stroke might unmask an otherwise missed disease. Consecutive patients with vertebrobasilar stroke were prospectively screened for GCA using erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin, and halo sign of the temporal and vertebral artery on ultrasound. Furthermore, we conducted a systematic literature review for relevant studies. Sixty-five patients were included, and two patients (3.1%) were diagnosed with GCA. Patients with GCA were older in age (median 85 versus 69 years, p = 0.02). ESR and CRP were significantly increased and hemoglobin was significantly lower in GCA patients compared to non-GCA patients (median, 75 versus 11 mm in 1 h, p = 0.001; 3.84 versus 0.25 mg/dl, p = 0.01, 10.4 versus 14.6 mg/dl, p = 0.003, respectively). Multiple stenoses/occlusions in the vertebrobasilar territory affected our two GCA patients (100%), but only five (7.9%) non-GCA patients (p = 0.01). Our literature review identified 13 articles with 136 stroke patients with concomitant GCA. Those were old in age. Headache, increased inflammatory markers, and anemia were frequently reported. Multiple stenoses/occlusions in the vertebrobasilar territory affected around 70% of stroke patients with GCA. Increased inflammatory markers, older age, anemia, and multiple stenoses/occlusions in the vertebrobasilar territory may be regarded as red flags for GCA among patients with vertebrobasilar stroke.
Highlights
Giant cell arteritis (GCA) can be diagnosed if at least three out of the following American College of Rheumatology criteria are met: age > = 50 years, new-onset localized headache, tenderness or reduced pulsation of the temporal artery (TA), increased erythrocyte sedimentation rate (ESR) > = 50 mm in the first hour and/or positive TA biopsy [1]
In a cross-sectional study, consecutive patients admitted to the Department of Neurology (University Hospital of Würzburg) with the diagnosis of VB-stroke were prospectively screened for the presence of halo sign of the extracranial vertebral artery (VA) and TA on both sides between February and October 2018
Of the 65 screened patients, halo sign of both TAs and at least one VA was detected in the two patients (3.1%) who were diagnosed with GCA, whereas the remaining patients (n = 63) did not show
Summary
Giant cell arteritis (GCA) can be diagnosed if at least three out of the following American College of Rheumatology criteria are met: age > = 50 years, new-onset localized headache, tenderness or reduced pulsation of the temporal artery (TA), increased erythrocyte sedimentation rate (ESR) > = 50 mm in the first hour and/or positive TA biopsy [1] These features may occur in stroke patients but may be underestimated; stroke survivors are usually old in age, headache after stroke does often not receive much attention and increased inflammatory markers after an ischemic. The European League Against Rheumatism (EULAR) recommended ultrasound examination of the TA as a first-line imaging modality in patients with suspected predominantly cranial GCA [13] With these considerations in mind, we investigated, whether screening for a halo sign of the TA and vertebral artery (VA) as well as for inflammatory markers in patients with VBstroke is useful to unmask a concomitant GCA
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