Bilateral ischemic optic neuropathy with multiple cranial nerve palsies in giant cell arteritis

A 66-year-old diabetic male presented to our center with a 3-day history of blurring of vision in the right eye, bilateral temporal headache, and diplopia. Fundus examination and optical coherence tomography revealed optic disc edema with optic atrophy of the left eye. The erythrocyte sedimentation...

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Main Authors: Richa Dhiman, Kuntal Patel, Nancy Sharma
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2025-07-01
Series:Journal of Clinical Ophthalmology and Research
Subjects:
Online Access:https://journals.lww.com/10.4103/jcor.jcor_125_24
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author Richa Dhiman
Kuntal Patel
Nancy Sharma
author_facet Richa Dhiman
Kuntal Patel
Nancy Sharma
author_sort Richa Dhiman
collection DOAJ
description A 66-year-old diabetic male presented to our center with a 3-day history of blurring of vision in the right eye, bilateral temporal headache, and diplopia. Fundus examination and optical coherence tomography revealed optic disc edema with optic atrophy of the left eye. The erythrocyte sedimentation rate and C-reactive protein levels were elevated. Color Doppler ultrasonography of the temporal artery revealed left-sided temporal artery wall thickening, which was suggestive of temporal arteritis. The patient was diagnosed with the right eye arteritic anterior ischemic optic neuropathy (A-AION) and the left eye posterior ischemic optic neuropathy (PION), with multiple cranial nerve palsies secondary to giant cell arteritis (GCA). There was a marked improvement in vision from finger counting to 6/36, with a significant improvement in headache after administering high-dose steroids. This case exemplifies the atypical presentation of GCA with bilateral vision loss due to PION in one eye and AION in the other eye if not diagnosed early.
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series Journal of Clinical Ophthalmology and Research
spelling doaj-art-6704205c948a4e738a9b3fa7a0e4a16d2025-08-20T03:44:31ZengWolters Kluwer Medknow PublicationsJournal of Clinical Ophthalmology and Research2320-38972320-39002025-07-0113340740910.4103/jcor.jcor_125_24Bilateral ischemic optic neuropathy with multiple cranial nerve palsies in giant cell arteritisRicha DhimanKuntal PatelNancy SharmaA 66-year-old diabetic male presented to our center with a 3-day history of blurring of vision in the right eye, bilateral temporal headache, and diplopia. Fundus examination and optical coherence tomography revealed optic disc edema with optic atrophy of the left eye. The erythrocyte sedimentation rate and C-reactive protein levels were elevated. Color Doppler ultrasonography of the temporal artery revealed left-sided temporal artery wall thickening, which was suggestive of temporal arteritis. The patient was diagnosed with the right eye arteritic anterior ischemic optic neuropathy (A-AION) and the left eye posterior ischemic optic neuropathy (PION), with multiple cranial nerve palsies secondary to giant cell arteritis (GCA). There was a marked improvement in vision from finger counting to 6/36, with a significant improvement in headache after administering high-dose steroids. This case exemplifies the atypical presentation of GCA with bilateral vision loss due to PION in one eye and AION in the other eye if not diagnosed early.https://journals.lww.com/10.4103/jcor.jcor_125_24giant cell arteritisheadacheischemic optic neuropathymultiple cranial nerve involvement
spellingShingle Richa Dhiman
Kuntal Patel
Nancy Sharma
Bilateral ischemic optic neuropathy with multiple cranial nerve palsies in giant cell arteritis
Journal of Clinical Ophthalmology and Research
giant cell arteritis
headache
ischemic optic neuropathy
multiple cranial nerve involvement
title Bilateral ischemic optic neuropathy with multiple cranial nerve palsies in giant cell arteritis
title_full Bilateral ischemic optic neuropathy with multiple cranial nerve palsies in giant cell arteritis
title_fullStr Bilateral ischemic optic neuropathy with multiple cranial nerve palsies in giant cell arteritis
title_full_unstemmed Bilateral ischemic optic neuropathy with multiple cranial nerve palsies in giant cell arteritis
title_short Bilateral ischemic optic neuropathy with multiple cranial nerve palsies in giant cell arteritis
title_sort bilateral ischemic optic neuropathy with multiple cranial nerve palsies in giant cell arteritis
topic giant cell arteritis
headache
ischemic optic neuropathy
multiple cranial nerve involvement
url https://journals.lww.com/10.4103/jcor.jcor_125_24
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AT kuntalpatel bilateralischemicopticneuropathywithmultiplecranialnervepalsiesingiantcellarteritis
AT nancysharma bilateralischemicopticneuropathywithmultiplecranialnervepalsiesingiantcellarteritis