She has identified a key mediator of the inflammatory processes in stroke, a protein called interleukin-1 IL She has identified cell sources of IL-1, which is known to act in the brain and in the rest of the body and has completed an early clinical trial of an IL-1 blocker in stroke patients.
She will talk about these findings, plans and hopes for the future. Her own research in the field of neuroscience has contributed towards major advances in the understanding and treatment of brain damage in stroke and head injury. He specialised in research on microwave electron tubes valves and produced seminal papers on electron velocity distributions and noise phenomena in magnetron devices. He was promoted to reader in and to a personal chair in physical electronics in Antibiotics were stopped after the initial sepsis screen was normal.
Her consciousness improved over a 48—72 hour period but she had residual dense right hemiplegia and mixed receptive and expressive dysphasia. Her nutrition and hence rehabilitation was impaired as a result of severe depression compounded by high dose steroids.
She needed supplementary naso-gastric tube feeding in the meantime. Her mood improved gradually over the next 3 months after commencement of 40 mg fluoxetine and gradual tapering of steroids by 10 mg every 6 weeks until a dose of 20 mg was reached. She was eventually discharged home but was bed-bound with severe spasticity of the upper limb.
It affects the cranial branches of the arteries originating from the aortic arch. However it may present atypically and stroke can be the presenting feature. It is reportedly the cause of first-ever stroke in only 0. The clinical features in the same distribution supported an ICA pathology as opposed to a cardioembolic source, which usually affects different territories.
This prompted discussions with neuroradiologists and hence a CT angiography was performed. Once a diagnosis is suspected it is imperative to start high dose steroids to prevent neuro-opthalmic complications. Aspirin has antiplatelet and anti-inflammatory properties and is hence important in such cases. It is important to discuss such atypical presentations with stroke teams so that relevant imaging and management be initiated without undue delay.
TAB is the cornerstone for diagnosis and remains positive up to six weeks of starting steroids. Clin Med Lond. Subramaniam Nagasayi , specialist registrar in geriatrics , A Susan White , consultant stroke physician , B and Yogesh Joshi , consultant neuroradiology and interventional radiologist C.
Author information Copyright and License information Disclaimer. Email: ku. Learning points GGCA should be suspected with patients aged above 50 years presenting with headaches and raised inflammatory markers. There is a need for awareness that GCA can cause strokes. Case presentation A year-old woman who was previously fit and well was admitted with a 6-week history of headaches and feeling generally unwell. Investigations Her initial investigations were as follows: haemoglobin, 9.
Open in a separate window. Fig 1. Differential diagnosis In view of the patient's headache, focal signs and inflammatory response, the differential diagnosis included stroke caused by large vessel vasculitis giant cell arteritis GCA or Takayasu arteritis , medium vessel vasculitis polyarteritis nodosa or small vessel vasculitis Churg Strauss syndrome, microscopic polyangitis or primary central nervous system CNS angitis , and stroke with infective aetiology occult septic foci with embolic stroke, cerebral abscess or meningitis.
Management On admission, on consideration of possible sepsis of unknown origin, an appropriate sepsis screen was undertaken without commencement of antibiotics. Fig 2. Fig 3. Fig 4. Discussion Giant cell arteritis is a common cause of headache in patients aged more than 50 years.
References 1. The diagnosis of giant cell arteritis. Rev Neurol Dis ; 4 — Diagnosis and treatment of giant cell arteritis. Drugs Aging ; 25 — The American College of Rheumatology criteria for the classification of giant cell -arteritis. Arthritis Rheum ; 33 —8. Wiszniewska M. Giant cell arteritis as a cause of first-ever stroke.
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