Giant Cell Arteritis Presenting with Lingual Artery Infarction (2711)

Objective: We report a case of giant cell arteritis presenting as lingual artery infarction and cerebellar strokes. Background: Giant Cell Arteritis (GCA) usually manifests with either unilateral vision loss, jaw claudication or polymyalgia rheumatica. Although much less common, unilateral lingual artery infarction is very specific for GCA. Design/Methods: We describe a case of a patient who presented with small cerebellar strokes, unilateral lingual artery infarction and elevation of acute phase reactants. Results: A 77-year-old Hispanic man with history of ulcerative colitis presented to the emergency department with dysarthria and altered mental status. Neurologically, he was confused and severely dysarthric. He was unable to protrude his tongue, and upon closer examination a clear demarcation of discoloration was noted on the right side of the tongue with ecchymoses and tenderness to palpation. His mental status improved, but not the dysarthria. Brain MRI revealed T2 hyperintensities on both cerebellar hemispheres, compatible with subacute infarcts. CTA of the head and neck, electrocardiogram, and 24-hour Holter monitor were unremarkable. Bloodwork was remarkable for elevated ESR at 80 mm/h and CRP at 39 mg/dl. Due to suspicion of giant cell arteritis, he was started on methylprednisolone 1 gr IV daily. A cerebral angiogram revealed multifocal segmental stenosis of all the branches of the ECA bilaterally, with some involvement of the vertebral arteries and ICA. A biopsy of the right occipital artery demonstrated transmural inflammation and disruption of internal elastic lamina with giant cells. His tongue necrosis slowly improved, and he was discharged on oral steroids. Conclusions: Our case provides a description of an uncommon presentation of GCA, unilateral lingual artery infarction and subacute strokes, without the classic GCA symptoms. It is important to recognize the association of lingual artery infarction with GCA, as early suspicion and prompt treatment with steroids result in a better outcome for these patients. Disclosure: Dr. De Leon Benedetti has nothing to disclose. Dr. Torres has nothing to disclose. Dr. Mannava has nothing to disclose. Dr. Margolesky has nothing to disclose.