Progressive and Fatal Brainstem Stroke in Systemic Giant Cell Arteritis

A 74-year-old woman presented with acute worsening of a 6-month long history of vertigo and postural instability with MRI evidence of cerebellar and brainstem acute infarcts. Extensive neurovascular assessment revealed a severe vascular damage with multiple stenoses and occlusions along the vertebrobasilar axis (Figure 1). Duplex ultrasonography showed hypoechoic halo sign along facial artery, whereas PET-CT highlighted increased fluorine-18-fluorodeoxyglucose uptake along vertebral and other larger arteries, thus allowing a diagnosis of giant cell arteritis (Figure 2).1,2 Despite prompt treatment with high-dose steroids and tocilizumab, which probably made uninformative a subsequent temporal artery biopsy (Figure 2), patient died of reported disability after strokes.

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