Introduction: Giant cell arteritis (GCA) is an uncommon cause of ischemic stroke (IS), leading to 0.11 % of first-ever IS.  GCA has a predilection for posterior circulation strokes secondary to segmental arterial wall inflammation of the vertebrobasilar system. Arterial dissection in the context of GCA is rare. In this study, we performed a systematic literature review of IS secondary to GCA, which were initially misinterpreted as dissection and present a case as such.

Methods: A systematic search was conducted, using Pubmed, MeSH, Ovid and Embase databases, to investigate peer-reviewed studies of GCA and stroke.

Results: We report a 70yo woman who presented with posterior circulation IS secondary to bilateral vertebral artery (VA) occlusion, thought to be secondary to dissection. There were no classic features of GCA other than an elevated ESR (48mm/h). Few weeks later she developed bilateral shoulder stiffness, was diagnosed with polymyalgia rheumatica and started on corticosteroids, to which her fluctuating neurological symptoms responded too. The admission CTA, demonstrated concentric thickening of the vessel walls of VAs (unlike the crescentic thickening seen in dissection) and subtle enhancement that made the diagnosis of GCA likely. A biopsy of the temporal artery confirmed the diagnosis. There are only two similar published cases.

Discussion: IS can be the first presentation of GCA without other classic features, and having a high clinical suspicion and a thorough knowledge of the vascular anatomical differences from other rare causes of IS can help differentiate GCA from them.

Stroke thought to be secondary to dissection: case report and systematic literature review.