Abstract Details

Title Giant Cell Arteritis and Area Postrema Syndrome: Where Do We Stand?

Topic Autoimmune Neurology

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

Poster/Presentation
Number 057

Objective NA

Background Giant cell arteritis is a common systemic vasculitis that affects vessels of medium and large size. The disease can present with a wide spectrum of clinical manifestations. In turn, a neuroinflammatory involvement of a structure located in the posterior medulla oblongata can cause hiccups, intractable nauseas and vomiting, recognized as area postrema syndrome. This work aims to show a case of giant cell arteritis presenting as an area postrema syndrome.

Design/Methods Case Report: A 64-year-old male presented an acute onset of hiccups, intractable nausea, and vomiting, but inappetence and weight loss had been occurring in the last two months. A wide investigation was carried out at that time, but all results were negative including CBA anti-AQP4. An increased signal on MRI was evidenced in the area postrema. Thus, a diagnosis of seronegative area postrema syndrome was considered and treatment with high-dose intravenous methylprednisolone was performed. 2 months later, the patient evolved with bitemporal headache, local hyperalgesia, and engorgement of temporal arteries. The diagnosis of giant cell arteritis was confirmed by biopsy.

Results Nonspecific symptoms such as fatigue, weight loss and headache are frequently found in subjects with giant cell arteritis. Moreover, the disease can present a lot of organic systems involvement. Neurological symptoms other than headache are less common but can occur. Albeit a subacute onset of symptoms is more common, an acute presentation occurs. Even though the spectrum of symptoms is broad, area postrema syndrome is not yet recognized as a clinical manifestation of giant cell arteritis.

Conclusions Giant cell arteritis is a common idiopathic entity with a vast clinical symptomatology. Nevertheless, area postrema syndrome does not figure among the possible clinical manifestations of the disease. Thus, this work highlights the possibility of this syndrome as a rare form of involvement of the central nervous system by giant cell arteritis.

Authors/Disclosures
Rafael Gemaque Lima Bentes PRESENTER	Mr. Gemaque Lima Bentes has nothing to disclose.
William Souza Martins Ferreira (Hospital Beneficência Portuguesa de SP)	Mr. Souza Martins Ferreira has nothing to disclose.
Matheus Alves A. Silva, MD (Beneficiencia Portuguesa)	Dr. Silva has nothing to disclose.
Barbara M. Carvalho (Hospital BP - Beneficencia Portuguesa de São Paulo)	Miss Carvalho has nothing to disclose.
	No disclosure on file
Hennan S. Teixeira, MD (Hospital Beneficencia Portuguesa De Sao Paulo)	Dr. Teixeira has nothing to disclose.
	No disclosure on file
Alex Baeta	Alex Baeta has nothing to disclose.

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