NPOG 2007 Abstract

Foredragsholder / Presenter

Navn / Name: Marianne Hove

Institution: Glostrup Hospital, Copenhagen

Afdeling / Department: Department of Ophthalmology

E-mail:m.hove@dadlnet.dk

Abstractet vil blive offentliggjort på NPOG 2007 hjemmesiden

The abstract will be published on the NPOG 2007 website

Medforfattere / Co-authors:

Navn / Name: Jon Peiter Saunte

Institution: Glostrup Hospital

Afdeling / Department: Department of ophthalmology

Navn / Name: Dan Milea

Institution: Glostrup Hospital

Afdeling / Department: Department of Ophthalmology

ABSTRACT

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Horizontal diplopia as the first sign of giant cell arteritis

Diplopia is a common symptom in giant-cell arteritis (GCA), and may be the sole initial symptom of the disease. Several mechanisms have been suggested to be responsible of diplopia : 1) direct vascular damage to the extraocular muscles. 2) ischemia involving ocular motor nerves, the sixth nerve being probably the most often involved cranial nerve. 3) direct brainstem involvement.

We report the case of a 70-year-old female presenting with a sixth nerve palsy leading to the diagnosis of GCA. She was referred for recent sudden onset of painless horizontal diplopia and ipsilateral facial swelling, and for longer time she had complained of diffuse headache, scalp tenderness and jaw claudication. The patient denied any visual signs, arthralgia, myalgia, fever or recent weight loss. Her past medical history was unremarkable, except for right eye amblyopia. Best corrected visual acuity was 20/70 OD and 20/50 OS. There was an isolated left abduction deficit, confirmed by Hess-Lancaster test. Fluorescein angiography including early phase pictures disclosed no abnormality. Erythrocyte sedimentation rate was 65 mm/h, and CRP was 100 mg/L. Since GCA was highly suspected, the patient was treated immediately with oral prednisolone (75 mg per day), with rapid pain relief. A temporal artery biopsy confirmed the clinically-suspected diagnosis. An MRI scan was performed, showing no cerebral or orbital abnormalities. Ocular motility progressively improved with complete recovery after seven weeks. She was treated with methotrexate and azathioprin besides from prednisolon but because of adverse effects it was tapered down, and after one year and five months infliximab was added.

Our patient was most possibly being affected by a 6 th nerve palsy, revealing giant cell arteritis. GCA is a treatable disease of the elderly and it is therefore essential to recognize the earliest symptoms to avoid blindness. Our patient did not experience visual loss because treatment was started in time, and her 6 th nerve palsy responded well on prednisolone.