Vessel Wall Magnetic Resonance Imaging of Bilateral Distal Internal Carotid Artery Stenosis in Intracranial Giant Cell Arteritis
Journal
Stroke: Vascular and Interventional Neurology
Journal Volume
3
Journal Issue
6
ISSN
2694-5746
Date Issued
2023-11
Author(s)
Abstract
A 61-year-old man with a 3-month history of headaches presented with recurrent episodes of right arm weakness and aphasia. Lipid profile and hemoglobin A1c level were normal. Erythrocyte sedimentation rate was 85 mm/h and blood C-reactive protein level was 21 mg/L. Magnetic resonance imaging (MRI) of the brain revealed left-sided internal border zone infarcts and MR angiography demonstrated severe bilateral distal internal carotid artery (ICA) stenosis. Dual antiplatelet therapy and intravenous methylprednisolone were initiated, given a differential diagnosis of intracranial atherosclerotic disease versus intracranial giant cell arteritis (IC-GCA). Despite optimal medical treatment, the patient developed new right-sided weakness and progressive aphasia, with serial MRIs showing corresponding new restricted diffusion foci in the left hemisphere (Figure He was then transferred for urgent endovascular treatment. Neurological examination revealed expressive aphasia, dysarthria, right central facial palsy, and worsening muscle strength (Medical Research Council grade 2) on the right side. Digital subtraction angiography confirmed severe stenosis of bilateral ICA from the cavernous segment to the supraclinoid segment (Figure Balloon angioplasty was performed on the left ICA.
SDGs
Publisher
Ovid Technologies (Wolters Kluwer Health)
Type
journal article