Abstract：
Giant Cell Arteritis (GCA), also known as Temporal Arteritis, is a type of large vessel vasculitis primarily affecting the elderly population. It typically manifests with headaches, visual impairment, and jaw claudication. Although third nerve palsy as the primary presentation of GCA is rare, it has been reported in previous instances. In this report, we describe the case of a patient presenting with pupil-sparing third nerve palsy, ultimately diagnosed with GCA, and successfully managed with steroids and tocilizumab. A lady in her 80s with past medical history of well-controlled hypertension, bladder cancer in remission, a twenty-pack year smoking history, cervical and lumbar spine stenosis, and recent immunizations presented with acute onset of right-sided pupil-sparing third nerve palsy. Labs were pertinent for an elevated ESR and CRP. Brain imaging was without acute abnormalities. A temporal artery biopsy established evidence of healed arteritis and a diagnosis of GCA was made. The patient was treated with pulse-dose steroids followed by an oral steroid taper and tocilizumab. At one month follow-up, there was partial resolution in her ophthalmoplegia. We underscore the importance of considering temporal arteritis as a potential cause of third nerve palsy in the elderly before attributing it solely to microvascular ischemia, particularly in patients with constitutional features. Additionally, in our comprehensive literature review, we aim to consolidate the existing data from similar presentations, shedding light on the clinical manifestation and disease trajectory.
摘要：
巨细胞动脉炎(GCA),也被称为颞动脉炎，是一种主要影响老年人群的大血管血管炎。它通常表现为头痛，视力障碍，还有颌骨跛行.虽然第三神经麻痹作为GCA的主要表现是罕见的，在以前的情况下已经有报道。在这份报告中,我们描述了一个患者出现保留瞳孔的第三神经麻痹的情况，最终诊断为GCA,并成功使用类固醇和托珠单抗治疗。一位80多岁的女士，既往高血压控制良好的病史，膀胱癌缓解期,有20年吸烟史,颈椎和腰椎狭窄，最近的免疫接种出现了右侧保留瞳孔的第三神经麻痹的急性发作。实验室与ESR和CRP升高有关。脑成像无急性异常。颞动脉活检确定了已治愈的动脉炎的证据，并诊断为GCA。患者接受脉冲剂量类固醇治疗，然后口服类固醇锥度和托珠单抗。在一个月的随访中，她的眼肌麻痹部分消退。我们强调在将颞动脉炎仅归因于微血管缺血之前，将其视为老年人第三神经麻痹的潜在原因的重要性。特别是有体质特征的患者。此外,在我们全面的文献综述中，我们的目标是整合来自类似演示文稿的现有数据，阐明临床表现和疾病轨迹。
