Abstract Details

Title A Rare Case of Giant Cell Arteritis Presenting With Transient Polycranial Neuropathies

Topic General Neurology

Presentation(s) P6 - Poster Session 6 (5:30 PM-6:30 PM)

Poster/Presentation
Number 2-004

Background

Case

A 72 year old man with a two week history of intermittent, right sided headache, subjective dysphagia presented with sudden onset lagophthalmos, mild perioral numbness, transient right facial droop lasting 20 minutes and binocular horizontal diplopia. On physical exam, the patient had mild bilateral lateral rectus muscle palsy. Work up included an unremarkable brain MRI, vessel imaging and MR venogram of the head. Lab work was significant for a CRP of 19, ESR of 83 however negative lyme antibody test. Lumbar puncture was unremarkable. The patient underwent a temporal artery biopsy with findings of necrotizing arteritis consistent with GCA. On hospital day 2, the diplopia resolved with steroids.

Objective

Giant cell arteritis (GCA) is characterized as vasculitis of large and medium sized blood vessels. Most feared complication of GCA remains painless permanent vision loss. GCA can rarely cause cranial nerve involvement. We present a case of biopsy proven GCA causing transient bilateral abducens and unilateral facial nerve involvement. So far this is the only case we know of that has been reported with facial nerve involvement.

Design/Methods NA

Results NA

Conclusions

Discussion

We report a case of biopsy proven GCA with atypical presentation of bilateral abducens and transient right facial nerve palsy. The patient also reported subjective dysphagia raising concern for vagus nerve palsy. There have been reports of GCA causing oculomotor, abducens, laryngeal and vestibulocochlear nerve palsy. Although vision loss is usually permanent, other cranial nerve palsies tend to resolve or improve. Our case adds to the multitude of findings that can be associated with GCA. GCA is an ophthalmic emergency and delay in diagnosis can cause permanent disability with vision loss. Hence, GCA should be part of differential for patient presenting with polycranial neuropathies.

Authors/Disclosures
Harinoor Mann, MBBS (Summa Health System Akron Campus Building 3, East Pavilion) PRESENTER	Dr. Mann has nothing to disclose.
Troy Desai, MD	Dr. Desai has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novartis. Dr. Desai has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Desai has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Desai has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Teva Neurosciences.