Sudden onset vision loss: an atypical presentation of giant cell arteritis and myeloproliferative neoplasm

2020 ◽  
Author(s):  
Khizar Rana ◽  
Carmen Oakley ◽  
David M Ross ◽  
Sumu Simon
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Vision Loss ◽  
Myeloproliferative Neoplasm ◽  
Sudden Onset ◽  
Atypical Presentation

scholarly journals The Thromboembolic Risk in Giant Cell Arteritis: A Critical Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
A. Guida ◽  
A. Tufano ◽  
P. Perna ◽  
P. Moscato ◽  
M. T. De Donato ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Vision Loss ◽  
Systemic Vasculitis ◽  
Granulomatous Inflammation ◽  
Cardiovascular Prevention ◽  
Sudden Onset ◽  
New Drugs ◽  
Rheumatological Disease

Giant cell arteritis is a systemic vasculitis characterized by granulomatous inflammation of the aorta and its main vessels. Cardiovascular risk, both for arterial and venous thromboembolism, is increased in these patients, but the role of thromboprophylaxis is still debated. It should be suspected in elderly patients suffering from sudden onset severe headaches, jaw claudication, and visual disease. Early diagnosis is necessary because prognosis depends on the timeliness of treatment: this kind of arteritis can be complicated by vision loss and cerebrovascular strokes. Corticosteroids remain the cornerstone of the pharmacological treatment of GCA. Aspirin seems to be effective in cardiovascular prevention, while the use of anticoagulant therapy is controversial. Association with other rheumatological disease, particularly with polymyalgia rheumatica is well known, while possible association with antiphospholipid syndrome is not established. Large future trials may provide information about the optimal therapy. Other approaches with new drugs, such as TNF-alpha blockades, Il-6 and IL-1 blockade agents, need to be tested in larger trials.

scholarly journals Challenges in the Diagnosis of Giant Cell Arteritis Before Visual Loss

2020 ◽  
pp. 1-5
Author(s):  
Purnima Mehta ◽  
Faaiq Hassan ◽  
Muhammed Omar Qadir ◽  
Shirish Dubey ◽  
Sergio Pagliarini ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Visual Loss ◽  
Systemic Vasculitis ◽  
The Elderly ◽  
Common Type ◽  
Atypical Presentation ◽  
Delay In Diagnosis ◽  
Atypical Presentations ◽  
High Index Of Suspicion

Background: Giant cell arteritis (GCA) is the most common type of systemic vasculitis affecting the elderly. Ophthalmic presentations of GCA in particular can be difficult to identify prior to permanent visual loss occurring. Methods: Here, we present 3 challenging cases as a retrospective series to highlight the variable presentations of GCA with ophthalmic involvement, but GCA was not suspected due to atypical presentation. Results: Unfortunately, all 3 cases went on to develop visual loss in the affected eye due to a delay in diagnosis or treatment. The authors wish to highlight the challenges posed to the referring clinicians, when patients had systemic/ocular co-morbidities, which delayed the suspicion of GCA Conclusion with a Practical Point: Our cases highlight the variable presentations of this condition as well as the devastating ophthalmic implications that GCA can have. A high index of suspicion must be maintained; particularly in elderly patients with atypical presentations.

scholarly journals Vision Loss in Patients with Giant Cell Arteritis Treated with Tocilizumab

2020 ◽  
Author(s):  
Jennifer Amsler ◽  
Iveta Kysela ◽  
Christoph Tappeiner ◽  
Luca Seitz ◽  
Lisa Christ ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Structural Changes ◽  
Vision Loss ◽  
Treated Patient ◽  
Laboratory Data ◽  
Reactive Protein ◽  
American College Of Rheumatology ◽  
Low Incidence ◽  
Initiation Of Therapy

Abstract Objectives: Giant cell arteritis (GCA) may lead to vision loss. To what extent tocilizumab (TCZ) is able to prevent vision loss is unknown. The aim was to analyze the occurrence of vision loss in a large GCA cohort treated with TCZ.Methods: In this observational monocentric study, GCA patients treated with TCZ between the years 2010 and 2018 were studied. Demographic, clinical and laboratory data were analyzed. Results: A total of 186 patients were included (62% female); 109 (59%) fulfilled the American College of Rheumatology (ACR) criteria, in 123 (66%) patients, large vessel vasculitis was diagnosed in magnetic resonance-angiography (MRA). Cumulative duration of TCZ treatment was 224 years, median treatment duration was 11.1 (IQR 5.6-17.9) months. Glucocorticoids (GC) were tapered over a median of 5.8 (IQR 3.0-8.5) months. At baseline, visual symptoms were present in 70 (38%) and vision loss in 21 (11%) patients. Patients with vision loss at baseline were older (p=0.032), had a lower C-reactive protein (p=0.002), more often cranial symptoms (p<0.001) or jaw claudication (p=0.031) and showed a negative association with MRA of the aorta (p=0.006). Two patients (1.1%) developed vision loss, both at initiation of TCZ treatment.Conclusion: Our data show a very low incidence of vision loss in TCZ-treated patient. The two cases of AION occurred at initiation of therapy, they support the hypothesis that advanced, and established structural changes of arteries are key factors for this accident. Whether shorter duration of concomitant GC treatment is risky regarding vision loss needs to be studied.

Vision Loss From Giant Cell Arteritis in Patients With Other Ocular Diagnoses

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Prem Nichani ◽  
Valérie Biousse ◽  
Nancy J. Newman ◽  
Jonathan A. Micieli
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Vision Loss

scholarly journals A hidden giant: Wallenberg syndrome and aortal wall thickening as an atypical presentation of a giant cell arteritis

2013 ◽  
Vol 2013 (mar01 1) ◽  
pp. bcr2012006994-bcr2012006994 ◽  
Author(s):  
K. L. Stengl ◽  
R. Buchert ◽  
H. Bauknecht ◽  
J. Sobesky
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Wall Thickening ◽  
Atypical Presentation ◽  
Wallenberg Syndrome

scholarly journals Atypical presentation of giant cell arteritis in a patient with vertebrobasilar stroke

Medicine ◽  
2019 ◽  
Vol 98 (32) ◽  
pp. e16737 ◽  
Author(s):  
Ahmed Mohamed Elhfnawy ◽  
Michael Bieber ◽  
Mira Schliesser ◽  
Peter Kraft
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Atypical Presentation ◽  
Vertebrobasilar Stroke

scholarly journals Evaluating the Incidence of Arteritic Ischemic Optic Neuropathy and Other Causes of Vision Loss from Giant Cell Arteritis

Ophthalmology ◽  
2016 ◽  
Vol 123 (9) ◽  
pp. 1999-2003 ◽  
Author(s):  
John J. Chen ◽  
Jacqueline A. Leavitt ◽  
Chengbo Fang ◽  
Cynthia S. Crowson ◽  
Eric L. Matteson ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Ischemic Optic Neuropathy

scholarly journals Giant Cell Arteritis Presenting as Choroidal Infarction

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Nikolaos Kopsachilis ◽  
Maria Pefkianaki ◽  
Anca Marinescu ◽  
Sobha Sivaprasad
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Vision Loss ◽  
Retinal Vessel ◽  
Interesting Case ◽  
Vessel Occlusion ◽  
Systemic Complications ◽  
Ocular Manifestations ◽  
Granulomatous Vasculitis ◽  
Choroidal Infarction

Background. Giant cell arteritis (GCA) is a systemic granulomatous vasculitis that affects large- and medium-sized arteries of the head and neck. Ocular manifestations of GCA usually are anterior ischaemic optic neuropathy (AION) or retinal vessel occlusion.Case Report. We report an interesting case of a 70-year-old man who presented with sudden vision loss and choroidal infarction in his left eye. Thorough clinical and paraclinical evaluation revealed an underlying GCA, the treatment of which prevented further vision loss and systemic complications.Conclusion. This is an unusual presentation of choroidal infarction associated with CGA and emphasizes the need of thorough systemic evaluation in patients with choroidal infarction.

Sign in / Sign up

Export Citation Format

Share Document