22. European Stroke Conference 184 Interesting and challenging cases A giant cause of posterior circulation stroke K. Kong1, A. Mackinnon2, G. Cloud3 Neurology Department, St George’s Hospital, London, UNITED KINGDOM1, Neurology Department, St George’s Hospital, London, UNITED KINGDOM2, Neurology Department, St George’s Hospital, London, UNITED KINGDOM3 Case History An 80-year-old man presented with a six-month history of lethargy, weight loss, decline in cognition and mobility. In the weeks preceding admission, he had become increasingly drowsy and confused. On admission, he was confused but had no focal neurological deficit. MRI brain showed both acute and subacute bilateral cerebellar, thalamic and pontine infarcts. It was noted that he had a raised ESR but no intercurrent infection. There was no evidence of any underlying malignancy and a my-eloma screen including bone marrow biopsy was also negative. Extracranial arterial imaging with MRA and CTA showed severe multifocal irregular narrowing of both vertebral arteries with a patent basilar artery. The extracranial carotid arteries and intracranial anterior circulation opacified normal-ly. Extracranial vasculitis was suspected. Despite the absence of scalp tenderness, his CTA showed one irregular superficial temporal artery. This facilitated a targeted temporal artery biopsy which confirmed the diagnosis of giant cell arteritis (GCA), showing full-thickness inflammation by lym-phocytes, macrophages and multinucleated giant cells. He was treated with a tapering dose of ste-roids. His repeat MRA 12 months later showed improvement in vertebral artery calibre and opaci-fication bilaterally. He made a significant functional recovery and has suffered no further stroke episodes. Discussion Non-specific neurological presentations may still be caused by stroke. In the event of a step-wise course, the possibility of an unusual cause of stroke should be considered. GCA is reported to cause stroke in 0.11% of patients. As with our patient, the posterior circulation is more commonly affect-ed than the anterior circulation in GCA, 50-75% compared to 15-20%, respectively. Biopsy is re-quired to confirm the diagnosis and in our patient the CTA was used to plan this. Conclusion GCA is a treatable cause of stroke and a potentially devastating diagnosis if it should be missed. 380 © 2013 S. Karger AG, Basel Scientific Programme
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