Intermittent Ophthalmoplegia as the Initial Manifestation of Giant Cell Arteritis

Abstract

Giant cell arteritis (GCA) is the most common form of vasculitis in elderly with multiple cardinal clinical features, such as headache associated with acute visual loss, jaw claudication and high inflammatory markers. GCA is readily treatable with immunosuppressants. Yet, if treated late, GCA could result in significant morbidities, such as aortic aneurysm, dissection, rupture and permanent visual loss. Early initiation of diagnostic evaluations, such as ultrasound of the temporal and axillary arteries and temporal artery biopsy, is thus very important. We present a case of an 84-year-old man who was diagnosed with GCA who presented with solely painless-intermittent ophthalmoplegia. He was later confirmed to have GCA with temporal artery ultrasound and biopsy. This case serves to emphasise the importance of recognising uncommon presentations of GCA and early initiation of its diagnostic tests and treatment.