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GCA — SCE Rheumatology MCQ

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HardVasculitisGCASCE Rheumatology

A 75-year-old woman has a 10-day history of a new temporal headache, scalp tenderness and jaw claudication. Twice today she has experienced painless complete loss of vision in her left eye lasting 2 minutes, with full recovery. Visual acuity and fundoscopy are currently normal. Her ESR is 96 mm/hour. If treatment is delayed, which complication is most immediately threatened?

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Correct answer: A — Irreversible monocular visual loss

The correct answer is A. The transient, painless monocular blackouts represent amaurosis fugax from ocular ischaemia in cranial GCA. A normal examination between episodes does not confer reassurance: this is a warning of impending irreversible visual loss, commonly from arteritic anterior ischaemic optic neuropathy, and requires immediate glucocorticoid treatment and urgent specialist assessment. Aortic aneurysm and dissection are important but generally later large-vessel complications rather than the immediate threat signalled here. GCA can cause vertebrobasilar stroke, but the recurrent monocular episodes localise the threatened vascular territory to the ophthalmic circulation. Upper-limb ischaemia is associated with axillary or subclavian involvement and is not suggested by this presentation.

Reference: British Society for Rheumatology. Diagnosis and treatment of giant cell arteritis, summary of the NICE-accredited BSR guideline, 2020. https://www.rheumatology.org.uk/news/details/articleid/217