Advances in Clinical Neuroscience & Rehabilitation (Mar 2020)

An atypical presentation of giant cell arteritis without headache

  • Bunting, Eva,
  • Barritt, Andrew W,
  • Leigh, Nigel,
  • Wright, David,
  • Rashid, Waqar

DOI
https://doi.org/10.47795/AMBA7231
Journal volume & issue
Vol. 20, no. 2
pp. 23 – 25

Abstract

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We describe an unusual case of giant cell arteritis initially manifesting as insidiously progressive spastic quadriparesis, widespread muscle wasting and fasciculations in the absence of headache, followed by a complete left pupil-involving 3rd nerve palsy 10 months later. MRI and CSF analysis revealed evidence of intracranial involvement with established white matter lesions and intrathecal oligoclonal bands, respectively, whilst whole body FDG-PET demonstrated isolated uptake within the descending aorta. The temporal arteries were clinically and radiologically unremarkable but biopsy showed transmural inflammation and multinucleate giant cells. A rapid, complete and sustained improvement followed steroid therapy.