Temporal arteritis presenting as third nerve palsy - a case report and review of literature

Giant Cell Arteritis (GCA), also known as Temporal Arteritis, is a type of large vessel vasculitis primarily affecting the elderly population. It typically manifests with headaches, visual impairment, and jaw claudication. Although third nerve palsy as the primary presentation of GCA is rare, it has...

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Bibliographic Details
Published in:	Rheumatology international Vol. 44; no. 10; pp. 2245 - 2251
Main Authors:	Arya PV, Akhila, Madathanapalli, Krishnasai Abhishek, Tenezaca, Felipe Carrasco, Wang, Andrew
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2024 Springer Nature B.V
Subjects:	Aged, 80 and over Antibodies, Monoclonal, Humanized - therapeutic use Case Based Review Female Giant Cell Arteritis - complications Giant Cell Arteritis - diagnosis Giant Cell Arteritis - drug therapy Humans Medicine Medicine & Public Health Neurological disorders Oculomotor Nerve Diseases - diagnosis Oculomotor Nerve Diseases - drug therapy Oculomotor Nerve Diseases - etiology Older people Rheumatology Treatment Outcome Giant cell arteritis Tocilizumab Third nerve palsy Temporal arteritis
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Summary:	Giant Cell Arteritis (GCA), also known as Temporal Arteritis, is a type of large vessel vasculitis primarily affecting the elderly population. It typically manifests with headaches, visual impairment, and jaw claudication. Although third nerve palsy as the primary presentation of GCA is rare, it has been reported in previous instances. In this report, we describe the case of a patient presenting with pupil-sparing third nerve palsy, ultimately diagnosed with GCA, and successfully managed with steroids and tocilizumab. A lady in her 80s with past medical history of well-controlled hypertension, bladder cancer in remission, a twenty-pack year smoking history, cervical and lumbar spine stenosis, and recent immunizations presented with acute onset of right-sided pupil-sparing third nerve palsy. Labs were pertinent for an elevated ESR and CRP. Brain imaging was without acute abnormalities. A temporal artery biopsy established evidence of healed arteritis and a diagnosis of GCA was made. The patient was treated with pulse-dose steroids followed by an oral steroid taper and tocilizumab. At one month follow-up, there was partial resolution in her ophthalmoplegia. We underscore the importance of considering temporal arteritis as a potential cause of third nerve palsy in the elderly before attributing it solely to microvascular ischemia, particularly in patients with constitutional features. Additionally, in our comprehensive literature review, we aim to consolidate the existing data from similar presentations, shedding light on the clinical manifestation and disease trajectory.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Review-3 content type line 23 ObjectType-Feature-5 ObjectType-Article-4 ObjectType-Report-1
ISSN:	1437-160X 0172-8172 1437-160X
DOI:	10.1007/s00296-024-05604-6