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A Diagnostic Approach to Giant Cell Arteritis Initially Presenting with Infarction without Headache Using MR Vessel Wall Imaging and a Temporal Artery Biopsy: A Case Report

Year: 2026

Type: article

Abstract: A 75-year-old woman presented with a sudden onset of left homonymous hemianopia and dizziness without headache. Magnetic resonance imaging revealed multiple posterior circulation infarctions, and magnetic resonance angiography revealed right vertebral artery occlusion and left vertebral artery stenosis. Vessel wall imaging (VWI) revealed concentric wall thickening with enhancement, suggesting vasculitis. 18F-FDG PET/CT revealed an increased aortic uptake. Despite elevated CRP and ESR levels, the temporal artery ultrasound was normal. A biopsy confirmed giant cell arteritis (GCA). Prednisolone and tocilizumab normalized the inflammatory markers. This case shows that GCA can present without classic symptoms, and VWI may help evaluate unexplained vascular lesions without conventional risk factors.

Source: Internal Medicine

DOI: 10.2169/internalmedicine.7447-26

Authors: Masaomi Yamamoto, Tomohisa Dembo, Keisuke Sawada, Yuichi Yoshida, Shunsuke Tsutsumi, Yoshihiro Furukawa, Satoru Oji, Kenichi Kaida

Institutions: Saitama Medical Center, Saitama Medical University, Saitama Medical University

Language: English

Topic: Vasculitis and related conditions

Subfield: Rheumatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7211889343

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