PMC4533393_01
Photomicrographs of the resected specimen. A: All three layers of the artery wall are severely affected by arteritis, and the artery wall architecture is destroyed. Hematoxylin and eosin stain, original magnification x40. B: The media and adventitia are infiltrated by inflammatory cells including multinucleated giant cells. Hematoxylin and eosin stain, original magnification x200 (high magnification of the black square in Fig. 1A). C: The internal elastic lamina is disrupted. Elastica-van Gieson stain, original magnification x200.
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F1
A biopsy of the superficial temporal artery was performed on the day 3 of hospitalization, and a diagnosis of GCA was confirmed on day 11 (Fig. 1).
Diffusion-weighted magnetic resonance images (upper row) and apparent diffusion coefficient maps (lower row) revealing fresh multiple infarcts in the cerebellar hemispheres and vermis, and the medulla oblongata.
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F2
Repeat CT revealed no definite abnormality, but cranial magnetic resonance (MR) imaging disclosed fresh infarctions in the cerebellar hemispheres and vermis, and the medulla oblongata (Fig. 2).
A: Catheter angiography by injection of the right subclavian artery revealing occlusion of the right vertebral artery (VA) near the take-off from the right subclavian artery (arrow). B: Cervical magnetic resonance (MR) angiography revealing stenosis of the left VA and no visualization of the right VA. C: Short tau inversion recovery MR image of the neck, axial view, revealing inflammation of the VAs (arrow). D: Cranial MR angiography revealing right VA occlusion and left VA stenosis (arrow). E: Follow-up cranial MR angiography revealing partial improvement of left VA stenosis and development of left anterior cerebral artery stenosis (arrow).
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F3
Catheter angiography revealed occlusion of the right vertebral artery (VA) near the take-off from the right subclavian artery (Fig. 3A). Cervical MR angiography revealed left VA stenosis with no visualization of the right VA (Fig. 3B), and short tau inversion recovery (STIR) images revealed inflammation of both VAs (Fig. 3C). Cranial MR angiography revealed right VA occlusion and left VA stenosis (Fig. 3D). Follow-up cranial MR angiography obtained approximately 3 months after surgery revealed partial improvement of left VA stenosis and development of left anterior cerebral artery stenosis (Fig. 3E).