Abstract Details

Title Giant Cell Arteritis of the Superior Mesenteric Artery Presenting with Wernicke Encephalopathy from Thiamine Deficiency

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 032

Objective N/A

Background Giant cell arteritis (GCA) is one of the most common systemic vasculitides in adults over the age of 50, with incidence ranging from 15 to 35 per 100,000 individuals. The disorder is commonly included in the differential diagnosis of maladies producing atypical facial pain / headache, visual loss / amaurosis fugax, jaw pain, elevated inflammatory markers, and anemia. The disorder is known to affect cranial arteries with typical physical exam findings that include tenderness of palpation to the temporal arteries and cranial neuropathies. Clinical diagnosis is supported by new headache, temporal artery abnormality, elevated ESR (≥50 mm/h), and abnormal artery biopsy.

Design/Methods N/A

Results A 68-year-old female with a history of primary generalized seizures presented to clinic with a 6-week history of paroxysms of acute confusional episodes, the inability to arise from a seated position due to bilateral lower extremity weakness, alterations of consciousness without loss of consciousness, severe anorexia, and weight loss. MRI with contrast including Axial FLAIR/T2/Diffusion revealed bilateral pan-lobar cortical and subcortical atrophy, with ex-vacuo ventriculomegaly and mild leukoaraiosis in the subcortical white matter tracts. PET-CT body revealed linear uptake involving the aortic root, extending into bilateral subclavian arteries, with segmental involvement of proximal common carotids, and extending inferiorly to the level of the common iliac arteries and the mesenteric arteries. Temporal artery biopsy revealed the presence of granulomas with multinucleated giant cells. Serology panel revealed pan hypovitaminoses in Vitamins A, B1, B6, B12, and D.

Conclusions Typical GCA workup initially resulted inconclusive for the patient, whose condition deteriorated as the patient’s altered mental status and dizziness spells continued unremittingly. This case highlights the link between large vessel vasculitis and malabsorption syndromes. The concept of parsimony links this patient’s arteritis with hypovitaminoses. The superior mesenteric artery (SMA) is classified as a medium vessel with its involvement in GCA unrecognized.

Authors/Disclosures
Sarah Shapiro (Kansas City University College of Osteopathic Medicine) PRESENTER	Miss Shapiro has nothing to disclose.
Ludovica Farese, MD (University of Utah School of Medicine)	Miss Farese has nothing to disclose.
David R. Renner, MD, FAAN	Dr. Renner has nothing to disclose.

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