Red flags for a concomitant giant cell arteritis in patients with vertebrobasilar stroke: a cross-sectional study and sy
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ORIGINAL ARTICLE
Red flags for a concomitant giant cell arteritis in patients with vertebrobasilar stroke: a cross‑sectional study and systematic review Ahmed Mohamed Elhfnawy1,2,3 · Doaa Elsalamawy2 · Mervat Abdelraouf2 · Mira Schliesser1 · Jens Volkmann1 · Felix Fluri1 Received: 25 January 2020 / Accepted: 20 March 2020 © Belgian Neurological Society 2020
Abstract Giant cell arteritis (GCA) may affect the brain-supplying arteries, resulting in ischemic stroke, whereby the vertebrobasilar territory is most often involved. Since etiology is unknown in 25% of stroke patients and GCA is hardly considered as a cause, we examined in a pilot study, whether screening for GCA after vertebrobasilar stroke might unmask an otherwise missed disease. Consecutive patients with vertebrobasilar stroke were prospectively screened for GCA using erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin, and halo sign of the temporal and vertebral artery on ultrasound. Furthermore, we conducted a systematic literature review for relevant studies. Sixty-five patients were included, and two patients (3.1%) were diagnosed with GCA. Patients with GCA were older in age (median 85 versus 69 years, p = 0.02). ESR and CRP were significantly increased and hemoglobin was significantly lower in GCA patients compared to non-GCA patients (median, 75 versus 11 mm in 1 h, p = 0.001; 3.84 versus 0.25 mg/dl, p = 0.01, 10.4 versus 14.6 mg/dl, p = 0.003, respectively). Multiple stenoses/occlusions in the vertebrobasilar territory affected our two GCA patients (100%), but only five (7.9%) non-GCA patients (p = 0.01). Our literature review identified 13 articles with 136 stroke patients with concomitant GCA. Those were old in age. Headache, increased inflammatory markers, and anemia were frequently reported. Multiple stenoses/occlusions in the vertebrobasilar territory affected around 70% of stroke patients with GCA. Increased inflammatory markers, older age, anemia, and multiple stenoses/occlusions in the vertebrobasilar territory may be regarded as red flags for GCA among patients with vertebrobasilar stroke. Keywords Giant cell arteritis · Vertebrobasilar stroke · Blood sedimentation · C-reactive protein · Hemoglobin · Stenosis
Introduction Giant cell arteritis (GCA) can be diagnosed if at least three out of the following American College of Rheumatology criteria are met: age > = 50 years, new-onset localized headache, tenderness or reduced pulsation of the temporal
artery (TA), increased erythrocyte sedimentation rate (ESR) > = 50 mm in the first hour and/or positive TA biopsy [1]. These features may also occur in stroke patients but may be underestimated; stroke survivors are usually old in age, headache after stroke does often not receive much attention and increased inflammatory markers after an ischemic
* Ahmed Mohamed Elhfnawy [email protected]
Felix Fluri [email protected]
Doaa Elsalamawy [email protected]
1
Mervat Abdelraouf [email protected]
Department of Neurology, University Hos
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