LAUSR

An 80-year-old man was admitted with sudden right eye vision loss secondary to acute ischemia of the optic nerve and subacute headache with elevated ESR (142 mm/h). A diagnosis of giant cell arteritis (GCA) was made, and the patient was started on methylprednisolone (intravenous, 1 g/d for 3 days) followed by oral prednisone (60 mg/d). Ten days later, he was admitted to our stroke center with severe aphasia (NIHSS 9). CT angiography revealed bilateral vertebral stenosis and bilateral internal carotid artery (ICA) stenosis in the ophthalmic segment (>90% stenosis) with extensive ischemic penumbra area on CT perfusion (Figure 1). Angioplasty of the left ICA was successfully performed with symptom improvement (Figure 1). Ultrasound-guided biopsy confirmed GCA (Figure 2). The patient continued prednisone (60 mg/d), methotrexate (20 mg/wk), and aspirin (100 mg/d). GCA commonly presents with vertebral stenosis and ICA stenosis.1 Intracerebral stenosis is a rare complication of CGA and is commonly refractory to medical therapy. Angioplasty is a potential rescue strategy to prevent ischemic complications.2