Giant Cell Arteritis: A Case-Based Narrative Review of the Literature

Abstract

Purpose of review: Giant cell arteritis (GCA) is a chronic, inflammatory condition, primarily affecting the medium and larger arteries. The purpose of this narrative review is to describe GCA in the context of headache and facial pain, based on a case and the available current literature. Understanding the etiology, pathophysiology, the associated conditions, and the differential diagnoses is important in managing GCA.

Recent findings: In a patient presenting with unilateral facial/head pain with disturbances of vision, GCA should be considered in the differential diagnosis. There is an association of GCA with several comorbid conditions, and infections including coronavirus-19 (COVID-19) infection. Management of GCA primarily depends upon the identification of the affected artery and prompt treatment. Permanent visual loss and other serious complications are associated with GCA. GCA is characterized by robust inflammation of large- and medium-sized arteries and marked elevation of systemic mediators of inflammation. An interdisciplinary approach of management involving the pertinent specialties is strongly recommended.

Keywords: Artery biopsy; Facial pain; Giant cell arteritis (GCA); Halo sign; Temporal arteritis; Vasculitis.

Fig. 1

A Longitudinal section showing perivascular hypoechoic halo. B Axial section showing the perivascular hypoechoic halo. The blue dot at the center designates the narrowed lumen

Fig. 2

Histopathological features of the biopsy specimen (TI, tunica intima; TM, tunica media; TA, tunica adventitia; H&E, hematoxylin and eosin)

Fig. 3

Schematic representation of the macro- and micro-anatomy of giant cell arteritis

Fig. 4

Comorbidities in giant cell arteritis