Open AccessRed flags for a concomitant giant cell arteritis in patients with vertebrobasilar stroke: a cross-sectional study and systematic review
Author(s) -
Ahmed Mohamed Elhfnawy,
Doaa Elsalamawy,
Mervat Abdelraouf,
Mira Schließer,
Jens Volkmann,
Felix Fluri
Publication year - 2020
Publication title -
acta neurologica belgica/acta neurologica belgica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.474
H-Index - 34
eISSN - 2240-2993
pISSN - 0300-9009
DOI - 10.1007/s13760-020-01344-z
Subject(s) - medicine , neuroradiology , giant cell arteritis , stroke (engine) , neurology , concomitant , cross sectional study , vertebrobasilar insufficiency , vertebral artery , radiology , pathology , vasculitis , disease , psychiatry , mechanical engineering , engineering
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.