Abstract Details

Title Rapid Bilateral Vision Loss due to Giant Cell Arteritis: A Case Series Highlighting the Need for Aggressive Inpatient Management

Topic Neurohospitalist

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 2-006

Objective To present two cases of Giant Cell Arteritis (GCA) resulting in rapid bilateral vision loss and to highlight the importance of prompt, aggressive inpatient treatment even in atypical cases.

Background GCA, also known as temporal arteritis, is a vasculitis of large- and medium-sized vessels that primarily affect individuals over 50 years old, peaking between 70 and 79 years. It can cause systemic inflammation, leading to vascular stenosis and aneurysm formation. Vision loss is the most feared complication and is often irreversible. Permanent partial or complete visual loss occurs in 8–20% of patients, and if untreated, up to 50% may experience vision loss in the contralateral eye. Early recognition and immediate high-dose corticosteroid therapy are critical to prevent progression.

Design/Methods Case series

Results

Case 1: A 76-year-old woman presented with several weeks of bilateral blurry vision followed by acute, painless vision loss. This was evaluated by ophthalmologists as an outpatient and no steroids were given. She denied headaches, jaw claudication, or scalp tenderness. Laboratory evaluation revealed markedly elevated inflammatory markers. Despite inpatient high-dose IV steroids and heparin for progressive ischemia, she developed complete bilateral blindness by hospital day four. Temporal artery biopsy confirmed by GCA.

Case 2: An 88-year-old woman presented with six days of painless, progressive vision loss. She had been on an outpatient prednisone taper (starting at 40 mg daily) for presumed GCA while waiting for the temporal biopsy results. Despite inpatient high-dose IV steroids, her partial left-eye vision deteriorated to complete bilateral blindness within 24 hours.

Conclusions These cases highlight the devastating visual outcomes of GCA despite aggressive treatment after the visual symptoms have progressed. Early recognition and initiation of high-dose corticosteroids in the inpatient setting are essential. Color Doppler ultrasonography (CDUS) should be considered a faster diagnostic adjunct when we can’t wait for biopsy confirmation.

Authors/Disclosures
Marcos R. Flores Valdés, MD PRESENTER	Dr. Flores Valdés has nothing to disclose.
Sambit Dash, MBBS	Dr. Dash has nothing to disclose.
Safwan Hyder, MD, PhD	No disclosure on file
Kevin R. Gurrala, DO	Dr. Gurrala has nothing to disclose.
JJ J. Janoyan, DO	Dr. Janoyan has nothing to disclose.

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