Ultrasound-guided diagnosis of an uncommon stroke: A case of giant cell arteritis

Abstract

Giant Cell Arteritis (GCA) is an immune-mediated vasculitis of large- and medium-sized vessels. Stroke happens in 3% to 7% of the cases, and identifying GCA properly is important because potentially curative treatment exists. We present a case of an 83-year-old woman, in whom suspected GCA was revealed by stroke caused by Vertebral Artery (VA) inflammation. The uncommon stroke localization and the ultrasound findings suggested vasculitic etiology of lesions. 18-Fluorodeoxyglucose-Positron Emission Tomography (18-FDG-PET) confirmed inflamed VA walls. Patient was treated with oral steroids and antiplatelet therapy, with improvement of clinical and ultrasonographic status. In our patient clinical diagnosis of GCA was challenging due to limited classical symptoms. Arguments in favor of arteritis were the symmetric and bilateral involvement of the VA, the sonographic halo sign and atypical stroke localization. Abbreviations: VA: Vertebral Artery; MRI: Magnetic Resonance Imaging; 18-FDG-PET: 18-Fluorodeoxyglucose-Positron Emission Tomography; AICA: Anterior Inferior Cerebellar Artery; PICA: Posterior Inferior Cerebellar Artery; GCA: Giant Cell Arteritis.