Design/Methods:
Case Report
Results:
A 72-year-old male was seen at the neuro-ophthalmology clinic for a right oculomotor palsy and right central retinal artery occlusion (CRAO) occurring within three days of each other. Stroke work up at an outside institution revealed the significant finding of a severe, right internal carotid stenosis for which a carotid endarterectomy was planned. The patient however developed a right CRAO before the endarterectomy could be performed. Though the patient reported experiencing headaches, unintentional weight loss, and jaw claudication as well as having elevated sedimentation rate, C-reactive protein, and platelet count at the time of initial presentation of the oculomotor palsy, the diagnosis of giant cell arteritis (GCA) was dismissed in favor of the carotid stenosis as the more likely etiology for the patient’s presentation. It was not until a couple of months after the patient’s initial diagnoses of right oculomotor palsy and CRAO that the diagnosis of GCA was made and appropriate treatment with steroids started.
Conclusions:
Though carotid stenosis has been reported as a cause of ischemic oculomotor palsies, this is much less common compared to GCA which has been known to cause diplopia from other extraocular cranial motor neuropathies as well as visual loss from arteritic ischemic optic neuropathy and CRAO. Though headaches and periocular pain could accompany ischemic extraocular motor neuropathies unrelated to GCA, clinicians should be more astute in recognizing other symptoms like jaw and tongue claudication, unintentional weight loss, anorexia, etc. that might indicate an alternative etiology–in this case, GCA–other than what is readily obvious, e.g., carotid stenosis. With both GCA and carotid stenosis having the potential to cause serious permanent disability, it is imperative to acknowledge the possibility of their coexistence and address each in the most appropriate and timely manner.