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Chapter 1.2 - Primary Systemic Vasculitis

from 1 - Inflammatory Conditions

Published online by Cambridge University Press:  06 October 2022

Anita Arsovska
Affiliation:
University of Ss Cyril and Methodius
Derya Uluduz
Affiliation:
Istanbul Üniversitesi
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Summary

Giant Cell Arteritis is a systemic vasculitis of unknown etiology that involves medium and large-sized vessels and has a tendency to involve extracranial branches of the carotid arteries. Ischemic complications of giant cell arteritis occur generally in patients with a yet undiagnosed or uncontrolled disease. Most common vascular complications are: anterior ischemic optic neuropathy, large-artery stenoses and ischemia, and, aortic aneurysms and dissections. Acute cerebrovascular ischemic events are a rare and severe complication of giant cell arteritis. The aim of this case report is to present a case of giant cell arteritis as a cause of stroke. The treatment of giant cell arteritis most commonly includes corticosteroids, but alternative therapy with corticosteroid sparing agents such as methotrexate, azathioprine, or tocilizumab, are available too. The treatment of acute stroke includes standard revascularization treatments in eligible patients (systemic thrombolysis and/or mechanical thrombectomy), as well as treatment in a stroke unit. In patients with giant cell arteritis who suffer stroke, secondary stroke prevention treatment is required as well as control of modifiable stroke risk factors. Antiplatelet therapy is cornerstone of the stroke prevention in majority of these patients, except in patients with cardioembolic stroke (particularly atrial fibrillation), where an oral anticoagulant therapy is recommended

Type
Chapter
Information
Rare Causes of Stroke
A Handbook
, pp. 10 - 16
Publisher: Cambridge University Press
Print publication year: 2022

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References

Nesher, G, Breuer, GS. Giant Cell Arteritis and Polymyalgia Rheumatica: 2016 Update. Rambam Maimonides Med J. 2016; 7.CrossRefGoogle ScholarPubMed
Gonzalez-Gay, MA, Vazquez-Rodriguez, TR, Lopez-Diaz, MJ, et al. Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum. 2009; 61:14541461.CrossRefGoogle ScholarPubMed
Ness, T, Bley, TA, Schmidt, WA, Lamprecht, P. The diagnosis and treatment of giant cell arteritis. Deutsches Arzteblatt Int. 2013; 110:376385.Google ScholarPubMed
Ness, T, Auw-Hadrich, C, Schmidt, D. [Temporal arteritis (giant cell arteritis). Clinical picture, histology, and treatment]. Ophthalmologe. 2006; 103:296301.Google ScholarPubMed
Gonzalez-Gay, MA, Lopez-Diaz, MJ, Barros, S. Giant cell arteritis: laboratory tests at the time of diagnosis in a series of 240 patients. Medicine. 2005; 84:277290.CrossRefGoogle Scholar
Schmidt, WA, Kraft, HE, Vorpahl, K, et al. Color duplex ultrasonography in the diagnosis of temporal arteritis. New Engl J Med. 1997; 337:13361342.CrossRefGoogle ScholarPubMed
Bley, TA, Reinhard, M, Hauenstein, C. Comparison of duplex sonography and high-resolution magnetic resonance imaging in the diagnosis of giant cell (temporal) arteritis. Arthritis Rheum. 2008; 58:25742578.Google Scholar
Blockmans, D. PET in vasculitis. Ann New York Acad Sci. 2011; 1228:6470.Google Scholar
Poller, DN, van Wyk, Q, Jeffrey, MJ. The importance of skip lesions in temporal arteritis. J Clin Pathol. 2000; 53:137139.CrossRefGoogle ScholarPubMed
Serling-Boyd, N, Stone, JH. Recent advances in the diagnosis and management of giant cell arteritis. Curr Opin Rheumatol. 2020; 32:201207.Google Scholar
Proven, A, Gabriel, SE, Orces, C, O’Fallon, WM, Hunder, GG. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum. 2003; 49:703708.CrossRefGoogle ScholarPubMed
Hellmich, B, Agueda, A, Monti, S, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2020; 79:1930.Google Scholar
Mahr, AD, Jover, JA, Spiera, RF, et al. Adjunctive methotrexate for treatment of giant cell arteritis: An individual patient data meta-analysis. Arthritis Rheum. 2007; 56:27892797.CrossRefGoogle ScholarPubMed
Hocevar, A, Jese, R, Rotar, Z, Tomsic, M. Does leflunomide have a role in giant cell arteritis? An open-label study. Clin Rheum. 2019; 38:291296.CrossRefGoogle ScholarPubMed
Kermani, TA, Warrington, KJ. Prognosis and monitoring of giant cell arteritis and associated complications. Exp Rev Clin Immunol. 2018; 14:379388.Google Scholar
Sailler, L, Paricaud, K. [Giant cell arteritis: Ischemic complications]. Presse Med. 2019; 48:948955.CrossRefGoogle ScholarPubMed
Pariente, A, Guedon, A, Alamowitch, S, et al. Ischemic stroke in giant-cell arteritis: French retrospective study. J Autoimmun. 2019; 99:4851.Google Scholar
Wilkinson, IM, Russell, RW. Arteries of the head and neck in giant cell arteritis: A pathological study to show the pattern of arterial involvement. Arch Neurol. 1972; 27:378391.CrossRefGoogle ScholarPubMed
Gonzalez-Gay, MA, Blanco, R, Rodriguez-Valverde, V, et al. Permanent visual loss and cerebrovascular accidents in giant cell arteritis: Predictors and response to treatment. Arthritis Rheum. 1998; 41:14971504.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Reich, KA, Giansiracusa, DF, Strongwater, SL. Neurologic manifestations of giant cell arteritis. Am J Med. 1990; 89:6772.CrossRefGoogle ScholarPubMed
Salvarani, C, Della Bella, C, Cimino, L, et al. Risk factors for severe cranial ischaemic events in an Italian population-based cohort of patients with giant cell arteritis. Rheumatology (Oxford). 2009; 48:250253.CrossRefGoogle Scholar
Nesher, G, Berkun, Y, Mates, M, et al. Risk factors for cranial ischemic complications in giant cell arteritis. Medicine. 2004; 83:114122.CrossRefGoogle ScholarPubMed
de Boysson, H, Liozon, E, Lariviere, D, et al. Giant cell arteritis-related stroke: A retrospective multicenter case-control study. J Rheumatol. 2017; 44:297303.CrossRefGoogle ScholarPubMed
Samson, M, Jacquin, A, Audia, S, et al. Stroke associated with giant cell arteritis: A population-based study. J Neurol Neurosurg Psychiatry. 2015; 86:216221.CrossRefGoogle ScholarPubMed
Powers, WJ, Rabinstein, AA, Ackerson, T, et al. Guidelines for the early management of patients with acute ischemic stroke. 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019; 50:e344e418.CrossRefGoogle Scholar
O’Donnell, MJ, Chin, SL, Rangarajan, S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): A case-control study. Lancet. 2016; 388:761775.CrossRefGoogle ScholarPubMed
Demarin, V, Rundek, T, Budincevic, H. Kaj je novega v smernicahobravnaveishemičnemožganskekapi/ What is new in the guidelines for ischemic stroke management? In: Žvan, BMZ (Ed.) Akutnamožganskakap. Ljubljana: Društvozapreprečevanjemožganskih in žilnihbolezni. 2015:167183.Google Scholar

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