An 89-year-old woman, with a history of arterial hypertension under treatment, who anamnestically commended the presence of physical decay, weight loss and frontotemporal headache interpreted as a 4-month history of depression at admission.
However, the installation of blurred vision associated with left eye pain (LE), which worsened in the last month due to eye pain and loss of vision of the right eye (OD) forced her to consult.
Evaluated in neuro-ophthalmology, a eye fundus was defined with pink, flat and net papillae.
In the left eye, ischemic whitenings (upper temporal) were observed towards the macula, which were interpreted as a possible area of arterial origin. The right third nerve palsy without pupillary involvement was also observed.
Due to these findings and a test that highlighted a CRP of 57.7 (VR: < 5.0), she was admitted to the Neurology Department of Hospital del Salvador with suspected temporal arteritis.
No symptoms of mandibular claudication or polymyalgia rheumatica were found in the hospitalization examination, nor were changes or indurations in the course of the temporal arteries observed.
His left vision was normal, but in the binocular view there was a spontaneous deviation of the left eye towards the outside and lower eye, which with the occlusion of the right eye, the left central eye vol to its
A loss of vision that only reached toes was observed.
The right eye presented a complete limitation for adduction and a minor limitation in elevation and depression.
No central or peripheral motor pathway involvement was found.
A laboratory study was completed highlighting ESR: 8 mm/h (VR: 1.0-24.0) and White count: 7,870 in normal range.
Magnetic resonance imaging of the brain in weighted T2-weighted sequences with fat saturation showed an increase in signal intensity in both superficial temporal arteries and periarterial soft tissues.
Contrast enhanced arterial wall and soft tissue enhancement was observed.
In addition, in T1WI with gadolinium, there was sheath impregnation of both optic nerves, irregular enhancement of intraconal and peripheral fat in both ophthalmic arteries.
Supraclinoid parietal enhancement of both carotid siphones.
Axial section in FLAIR and diffusion of the same slice shows cerebellar acute ischemic lesions on the right side.
In TOF significant irregularities of the V4 segment of both vertebral arteries.
The study was complemented with color Doppler echocardiography with high frequency linear transducer, which showed decreased lumen of both superficial temporal arteries, more important on the left side, with hypoechogenic parietal thickening.
Intravenous dexamethasone was started, which had to be suspended on the third day due to an acute confusional episode, attributed to the treatment, was changed by boluses of methylprednisolone for 3 days and then oral prednisone.
The patient remained painless, with little language and a certain quantitative compromise of consciousness.
New onset corticoids appeared in the left hemibody hypotonia associated with ipsilateral Babinski's sign, which the control CT could associate bilateral cerebellar hypodensity and hypodensity of the right occipital lobe.
