case_images: PMC10559434_01
case_images: (a) Diffusion-weighted image revealed cerebral infarctions in the left and right sides of the pons and cerebellum, and (b) the left internal carotid artery (ICA) and the right vertebral artery (VA) were not well visualized in magnetic resonance angiography (arrow). Digital subtraction angiography revealed (c) occlusion of the V4 portion of the right VA and (d) stenosis of the V4 portion of the left VA (arrow), as well as (e) occlusion of the left supraclinoid ICA. (f) Meanwhile, no clear stenosis of the superficial temporal artery was observed.
case_images: SNI-14-332-g001.jpg
case_images: PMC10559434_01_SNI-14-332-g001.jpg
case_images: F1
case_images: MRI revealed infarction lesions in the left and right sides of the pons and cerebellum [Figure 1a], while the left internal carotid artery (ICA) and the right vertebral artery (VA) were not well visualized in magnetic resonance angiography (MRA) [Figure 1b]. Digital subtraction angiography (DSA) revealed occlusion of the V4 portion of the right VA [Figure 1c], stenosis of the V4 portion of the left VA [Figure 1d], and occlusion of the left supraclinoid ICA [Figure 1e]. No clear stenotic lesion was observed in the superficial temporal artery (STA) [Figure 1f].
case_images: (a) Diffusion-weighted magnetic resonance imaging revealed a new cerebral infarction in the left pons. (b) In the front view of digital subtraction angiography (DSA), the right posterior cerebral artery and the right superior cerebellar artery showed laminar flow (arrow) due to blood flow through the right posterior communicating artery, and blood flow from the left vertebral artery was predicted to be reduced. (c) The lateral view of DSA revealed a narrowing of the superficial temporal artery at multiple sites (arrow).
case_images: SNI-14-332-g002.jpg
case_images: PMC10559434_01_SNI-14-332-g002.jpg
case_images: F2
case_images: MRI revealed a new cerebral infarction in the left pons [Figure 2a]. DSA showed aggravation of the stenotic lesion in the left VA and laminar flow in the right posterior cerebral artery and superior cerebellar artery due to blood flow through the right posterior communicating artery [Figure 2b]. Moreover, multiple stenotic lesions were observed in the STA [Figure 2c].
case_images: No intracranial vascular lesions were observed in the magnetic resonance angiography acquired at the onset of the signs of giant cell arteritis.
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case_images: PMC10559434_01_SNI-14-332-g003.jpg
case_images: F3
case_images: As the MRA data showed no vascular lesions, such as stenosis or occlusion, in cerebral vessels [Figure 3], we understood that the vascular lesions were aggravated rapidly within 3 months.
case_images: T1 black-blood post-gadolinium imaging sequence magnetic resonance imaging. (a) Vessel wall enhancement (VWE) of the V4 portion of the right vertebral artery (VA) was observed (arrow). (b) More distally, the right VA was occluded (arrow), and the VWE of the V4 portion of the left VA was observed (triangle). (c) VWE was observed in the petrous portion of the left internal carotid artery (ICA) (arrow), and VWE was also observed in the left and right superficial temporal artery (triangle). (d) Occlusion was observed in the supraclinoid portion of the left ICA (arrow).
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case_images: PMC10559434_01_SNI-14-332-g004.jpg
case_images: F4
case_images: T1 black-blood post-gadolinium imaging sequence MRI revealed vessel wall enhancement (VWE) in the left and right VA, left ICA, and left and right STA [Figures 4a-d].
case_images: Photographs of pathological sections of the biopsied temporal artery. (a) Elastica van Gieson staining revealed the rupture of the elastic lamina near the intima (arrow) and the narrowing of the vessel lumen due to the marked thickening of the intima (triangle). (b) Hematoxylin and eosin staining revealed multinucleated giant cells in the media (arrow) and infiltration of histiocytes and lymphocytes.
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case_images: PMC10559434_01_SNI-14-332-g005.jpg
case_images: F5
case_images: The level of myeloperoxidase-anti-neutrophil cytoplasmic antibody, serine proteinase3-anti-neutrophil cytoplasmic antibody, anti-cyclic citrullinated peptide antibody, anti-double stranded DNA immunoglobulin G, and anti-Sm antibody was normal. The patient was suspected of having vasculitis, and a temporal artery biopsy was performed before she was finally diagnosed with GCA [Figures 5a and b].
case_images: In the magnetic resonance angiography acquired 9 months after discharge, no progression of intracranial vascular lesions was observed, but the visualization of the left internal carotid artery and the right vertebral artery (VA) did not improve, and the left VA also remained poorly visualized (arrow).
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case_images: PMC10559434_01_SNI-14-332-g006.jpg
case_images: F6
case_images: As of 9 months after discharge, the oral prednisolone dose was gradually reduced to 10 mg/day, and MRA showed no aggravated intracranial vascular lesions [Figure 6], and very mild dysarthria was the only residual neurological symptom.