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Bilateral Optic Sheath Enhancement in Giant Cell Arteritis (GCA) Presenting With Occipital Neuralgia-Like Symptoms

Year: 2025

Type: article

Abstract: We present the case of an 86-year-old woman admitted with a two-week history of a bilateral occipital burning sensation, without fever, jaw claudication, or neck stiffness. Laboratory investigations revealed a markedly elevated C-reactive protein (CRP) level of 284 mg/L. Magnetic resonance imaging (MRI) of the head with contrast demonstrated bilateral hyperenhancement of the optic nerve sheaths. Although optic nerve signal changes are an uncommon manifestation of giant cell arteritis (GCA), the neurology team commenced high-dose oral prednisolone (60 mg once daily), considering GCA in the differential diagnosis. The patient showed rapid symptomatic and biochemical improvement following steroid initiation. Subsequent temporal artery ultrasound findings were consistent with GCA, supporting the diagnosis. This case highlights an unusual radiological presentation of GCA and underscores the importance of early empirical treatment to prevent irreversible visual complications.

Source: Cureus

DOI: 10.7759/cureus.98136

Authors: Ahmed Malik Abuelgasim Malik, Hossam Malik Abdalla, Yun Zou, Thomas Lambert

Institutions: University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Midlands Partnership NHS Foundation Trust

Language: English

Topic: Vasculitis and related conditions

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4416826837