The authors report the case of a 59-year-old woman without apparent vascular risk factors who presented with right-sided hemiparesis and a small acute left frontal brain infarction. They conclude that multiple findings suggest that the case may represent a distinct manifestation of giant cell arteritis with predilection of the basal cerebral arteries and not typical giant cell arteritis.
High-resolution black-blood T1-weighted magnetic resonance imaging (MRI) demonstrated marked contrast enhancement in the terminal segment of the left internal carotid artery and the left posterior communicating artery. This was correlated with digital subtraction angiography (DSA) results. Erythrocyte sedimentation rate (ESR) test results were normal. Histology of the basal cerebral arteries after the patient's death revealed severe vasculitic alterations and multinucleated giant cells.
The absence of extracranial artery involvement and a normal ESR argue against a diagnosis of typical giant cell arteritis, the authors said. They also conclude that black-blood T1-weighted MRI may be valuable in the diagnosis of diseases in which vessel wall inflammation may play a role.
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