A Diagnostic Approach to Giant Cell Arteritis Initially Presenting with Infarction without Headache Using MR Vessel Wall Imaging and a Temporal Artery Biopsy: A Case Report.

A 75-year-old woman presented with a sudden onset of left homonymous hemianopia and dizziness without headache. Magnetic resonance imaging revealed multiple posterior circulation infarctions, and magnetic resonance angiography revealed right vertebral artery occlusion and left vertebral artery stenosis. Vessel wall imaging (VWI) revealed concentric wall thickening with enhancement, suggesting vasculitis. 18F-FDG PET/CT revealed an increased aortic uptake. Despite elevated CRP and ESR levels, the temporal artery ultrasound was normal. A biopsy confirmed giant cell arteritis (GCA). Prednisolone and tocilizumab normalized the inflammatory markers. This case shows that GCA can present without classic symptoms, and VWI may help evaluate unexplained vascular lesions without conventional risk factors.