When Two is More Than Too Much: Carotid Stenosis and Giant Cell Arteritis (P1-9.002)

Abstract

<h3>Objective:</h3> NA <h3>Background:</h3> NA <h3>Design/Methods:</h3> Case Report <h3>Results:</h3> A 72-year-old male was seen at the neuro-ophthalmology clinic for a right oculomotor palsy and right central retinal artery occlusion (CRAO) occurring within three days of each other. Stroke work up at an outside institution revealed the significant finding of a severe, right internal carotid stenosis for which a carotid endarterectomy was planned. The patient however developed a right CRAO before the endarterectomy could be performed. Though the patient reported experiencing headaches, unintentional weight loss, and jaw claudication as well as having elevated sedimentation rate, C-reactive protein, and platelet count at the time of initial presentation of the oculomotor palsy, the diagnosis of giant cell arteritis (GCA) was dismissed in favor of the carotid stenosis as the more likely etiology for the patient’s presentation. It was not until a couple of months after the patient’s initial diagnoses of right oculomotor palsy and CRAO that the diagnosis of GCA was made and appropriate treatment with steroids started. <h3>Conclusions:</h3> Though carotid stenosis has been reported as a cause of ischemic oculomotor palsies, this is much less common compared to GCA which has been known to cause diplopia from other extraocular cranial motor neuropathies as well as visual loss from arteritic ischemic optic neuropathy and CRAO. Though headaches and periocular pain could accompany ischemic extraocular motor neuropathies unrelated to GCA, clinicians should be more astute in recognizing other symptoms like jaw and tongue claudication, unintentional weight loss, anorexia, etc. that might indicate an alternative etiology–in this case, GCA–other than what is readily obvious, e.g., carotid stenosis. With both GCA and carotid stenosis having the potential to cause serious permanent disability, it is imperative to acknowledge the possibility of their coexistence and address each in the most appropriate and timely manner. <b>Disclosure:</b> An immediate family member of Dr. Santos has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Horizon Therapeutics. An immediate family member of Dr. Santos has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cochrane. Dr. Santos has stock in Gilead Sciences. Dr. Santos has stock in Novocure. Dr. Santos has stock in Shockwave Medical. Dr. Santos has stock in Teva. An immediate family member of Dr. Santos has received research support from American Academy of Neurology. The institution of an immediate family member of Dr. Santos has received research support from Trinity Health Saint Mary’s Foundation. An immediate family member of Dr. Santos has a non-compensated relationship as a Delegate with AAN Neurology on the Hill that is relevant to AAN interests or activities. An immediate family member of Dr. Santos has a non-compensated relationship as a Participant with AAN Palatucci Advocacy Leadership Forum that is relevant to AAN interests or activities. An immediate family member of Dr. Santos has a non-compensated relationship as a Scholar with AAN Health Equity Symposium Scholarship that is relevant to AAN interests or activities. An immediate family member of Dr. Santos has a non-compensated relationship as a Participant with AAN Emerging Leaders Program that is relevant to AAN interests or activities.