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
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.
Related
- Lung Cancer Initially Presenting with Diffuse Alveolar Damage and Brain Infarction: An Autopsy Case Report
- Giant Cell Arteritis Presenting as Recurrent Left Middle Cerebral Artery Territory Infarction.
- P084 Beyond headache: an atypical relapse of giant cell arteritis presenting with fatigue and dizziness
- [Chronic lymphocytic leukemia presenting initially as purpura nephritis: a case report].
- Agreement between initial in-person and follow-up telemedicine assessment in patients presenting with first-time headache
BibTeX
@article{yamamoto2026diagnostic,
title = {{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}},
author = {Masaomi Yamamoto and Tomohisa Dembo and Keisuke Sawada and Yuichi Yoshida and Shunsuke Tsutsumi and Yoshihiro Furukawa and Satoru Oji and Kenichi Kaida},
journal = {Internal Medicine},
year = {2026},
month = sep,
doi = {10.2169/internalmedicine.7447-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7447-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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
AU - Masaomi Yamamoto
AU - Tomohisa Dembo
AU - Keisuke Sawada
AU - Yuichi Yoshida
AU - Shunsuke Tsutsumi
AU - Yoshihiro Furukawa
AU - Satoru Oji
AU - Kenichi Kaida
PY - 2026
DA - 2026/09/08
JO - Internal Medicine
DO - 10.2169/internalmedicine.7447-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7447-26/_article
AB - 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.
SN - 1349-7235
SN - 0918-2918
ER -