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Giant cell arteritis with visual symptoms — SCE Acute Medicine MCQ

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HardNeurology and ophthalmologyGiant cell arteritis with visual symptomsSCE Acute Medicine

A 76-year-old woman presents with 3 weeks of scalp tenderness, jaw claudication and new transient visual loss in the left eye. ESR is 92 mm/hour and platelets are 510 x 10^9/L. Visual acuity is reduced and temporal artery is tender. What is the most appropriate next step in management?

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Correct answer: A — Start high-dose glucocorticoids immediately and arrange urgent specialist assessment

Giant cell arteritis with visual symptoms requires immediate high-dose glucocorticoids to reduce risk of irreversible sight loss. Biopsy or ultrasound should be arranged urgently but must not delay treatment. The key clue is cranial ischaemic symptoms with inflammatory markers and thrombocytosis in an older patient.

Reference: BSR guideline on giant cell arteritis; NICE CKS giant cell arteritis