Description

Giant cell arteritis (GCA) is an idiopathic necrotising vasculitis affecting primarily the cranial branches arising from the aortic arch. It may also be known as temporal arteritis, or Horton’s disease after the doctor who described the characteristic pathological changes in 1932. The clinical condition was first described by Hutchinson in 1890.

The most commonly seen ophthalmic manifestation of GCA is an anterior ischaemic optic neuropathy (AION) secondary to a vasculitis of the short posterior ciliary arteries. Six to fourteen per cent of AIONs are arteritic, with GCA the predominant cause, the remainder are non-arteritic and are associated with vascular risk factors such as diabetes mellitus, systemic hypertension and hyperlipidaemia. If patients with GCA remain untreated 25-50% will develop profound permanent visual loss because of AION. Second eye involvement occurs within 10 days in 65% of this group. We describe the case of an elderly lady with GCA who presented with acute dysarthria and tongue necrosis, followed 3 weeks later by an AION affecting the right eye.