Bilateral MCP Infarct Due to Vertebral Giant Cell Arteritis

Fatal posterior circulation stroke with persistent hiccups, sinus arrest and post-hiccup syncope: A case report

RATIONALE

Diagnosis of posterior circulation stoke is difficult, and magnetic resonance imaging especially diffusion-weighted imaging is superior to computed tomography. Persistent hiccups, sinus arrest, and post-hiccup syncope are extremely rare symptoms of posterior circulation stroke. However, there is no effective treatment for persistent hiccup.

PATIENT CONCERN AND DIAGNOSIS

We describe a case of a 58-year-old hypertensive woman diagnosed with acute posterior circulation stroke who presented with persistent hiccups, sinus arrest, and post-hiccup syncope. Diffusion-weighted imaging revealed a high-intensity signal involving the left middle cerebellar peduncle and several spotted areas in the right occipital lobe.

INTERVENTIONS

Permanent pacemaker was implanted and metoclopramide was used to treat persistent hiccups.

OUTCOME

The patient developed aspiration pneumonia and morbid dysphoria, and eventually died.

LESSONS

Posterior circulation stroke can cause cardiovascular and respiratory dysfunction. Consequently, physicians should pay more attention to posterior circulation lesions in patients with arrhythmia and syncope. An effective method to treat persistent hiccups is urgently needed.

A case of giant cell arteritis lacking typical symptoms presenting with recurrent cerebellar infarctions: A case report and case-based review

Giant cell arteritis (GCA) occasionally presents with ischaemic stroke. Generally, symptoms related to GCA or elevated levels of inflammation markers would be a clue for the diagnosis of GCA. However, we encountered a rare case of GCA that presented with recurrent cerebellar infarctions without symptoms related to GCA (headache, fever, or jaw claudication). Furthermore, C-reactive protein levels, measured at the time of two of the stroke attacks, were within the normal range. On physical examination, the temporal arteries were prominent and weakly pulsatile. Temporal artery ultrasonography showed halo signs, and temporal artery biopsy revealed GCA. To our knowledge, this is the first case of GCA presenting with recurrent ischaemic stroke lacking GCA features but diagnosed before death. Considering this case-based review, we suggest that GCA may have been missed in elderly patients with ischaemic stroke, especially in those with posterior circulation infarction. Therefore, physical examination of the temporal arteries, temporal artery ultrasonography, and vessel wall magnetic resonance imaging may be useful in those patients.