Stroke and Multi-Infarct Dementia as Presenting Symptoms of Giant Cell Arteritis (original) (raw)
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Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis
Arthritis & Rheumatism, 2004
Objective. Cranial ischemic complications such as cerebrovascular accidents (CVAs) and acute visual loss are among the leading causes of giant cell arteritis (GCA)-related morbidity. In this retrospective study, we evaluated the effect of treatment with low-dose aspirin on the incidence of cranial ischemic complications in GCA.
Giant cell arteritis: diagnosis and management
Current Opinion in Ophthalmology, 2001
Giant cell arteritis (GCA), also known as temporal or cranial arteritis, is a systemic vasculitis of adults that is the most common arteritis in western countries. 1 The general disease state has been known for over a century, after a "peculiar form of arteritis in the aged" was reported in 1890. 2 GCA was pathologically confirmed in 1932. 3 The disorder is generally a panarteritis limited to vessels with an internal elastic component, 4 and it usually affects the extracranial branches of the carotid artery, although it may extend to other vessels as well. 5-7 Temporal arteritis, which affects the temporal artery, is the most common form of GCA. 8 There is a wide array of clinical characteristics associated with the disease. The single greatest risk factor for GCA in its various forms is advancing age 9,10 ; the disease almost exclusively affects persons older than 50 years, with an average of onset of age 72 years and an average incidence of 1.54 per 100,000 persons during the sixth decade of life. 11 The annual incidence rises steadily after the sixth decade, reaching 20.7 per 100,000 persons by the eighth decade of life 11 and then 1100 per 100,000 persons by age 85 or older. 12 By gender, age-adjusted estimates indicate a female preponderance; for persons older than 50 years, the incidence in women is 24.2 per 100,000 and in men is 8.2 per 100,000. 13 These figures, combined with a recognition of the aging US population, 14 suggest the significant cost that the morbidity associated with the disorder represents. Although GCA affects patients in all cultural and racial groups, it has been reported as particularly common in patients with Scandinavian and other northern European backgrounds. 5 Prevalence increases as residence moves from southern latitudes to northern ones. 15 White persons are much more affected by the disease than are black, Hispanic, or Asian persons. The exact mechanism of the disease process in GCA is unknown but is thought to be T-cell dependent and
Seminars in Arthritis and Rheumatism, 2019
Background: We examined the initial features, course, and prognosis of giant cell arteritis (GCA) in patients ≥ 85 years of age (≥85 y) and compared them to those of younger patients. Methods: The present retrospective study included all patients who were newly diagnosed with GCA in the Internal Departments of two French University Hospitals from 1976 or 1998 to 2017 and who were followed up for at least 6 months. Logistic regression analyses were conducted to identify baseline and prognostic characteristics associated with being ≥85 y. Results: Of the 865 patients assessed in this study, 87 were ≥85 y. Compared to younger patients, patients ≥ 85 y had more comorbid conditions (odds ratio [OR]=1.11-1.74, p<0.01), less often exhibited polymyalgia rheumatica (PMR; OR=0.33-0.96, p = 0.04), and more often developed permanent visual loss (OR=1.29-3.81, p<0.01). The older patients also showed less dependence on glucocorticoid (GC) medications (OR=0.23-0.94, p=0.04), had fewer relapses (OR = 0.31-0.87, p = 0.015), less often recovered from GCA (OR=0.22-0.69, p<0.01), and more often died during treatment (OR=1.45-4.65, p=0.001) compared to younger patients. Being ≥85 y was the only factor associated with an increased 1-year mortality (hazard ratio=1.77-5.81, p=0.0001) for the whole cohort. Conclusions: GCA in very elderly patients was characterized by a higher rate of severe ischemic complications and an increased risk for early death compared to younger patients. Thus, there is a need for the early diagnosis of GCA and close clinical monitoring in this unique population.
Stroke secondary to giant‑cell arteritis: A literature review
Experimental and Therapeutic Medicine
Stroke is a leading cause of death and disability worldwide. In addition to the classical etiologies of stroke as atherosclerosis and cardioembolism there are many unusual, rare causes, which require a high level of clinical suspicion and further investigations for correct and early diagnosis and adequate treatment. Giant-cell arteritis or temporal arteritis, the most frequent vasculitis in the elderly population is one of the uncommon causes of stroke. In the setting of giant-cell arteritis, stroke more likely affects the vertebrobasilar territory and is the main cause of mortality. Duplex ultrasound examination is a routine investigation for stroke patients and may be key to the diagnosis if the classical hypoechoic 'halo sign' is recognized at the level of vertebral arteries. In this situation the ultrasound evaluation of temporal arteries and temporal artery biopsy are mandatory. The Giant-cell arteritis-related stroke is a rare condition; therefore, there are no evidence-based guidelines or standard recommendations for the treatment. In the present review, the main characteristics of giant-cell arteritis-related stroke are discussed.
Rheumatology, 2008
Objective. To evaluate the impact of traditional cardiovascular risk factors, carotid atherosclerosis and the effect of anti-platelet/ anti-coagulant therapy on the occurrence of severe cranial ischaemic events (CIEs) in GCA. Methods. We identified 180 Reggio Emilia (Italy) residents with biopsy-proven GCA diagnosed between 1986 and 2005. We evaluated data on demographics, clinical features, laboratory investigations, cardiovascular risk factors, anti-platelet/anti-coagulant use and carotid atherosclerosis.