[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-408011-105":59,"doc-detail-408011-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","when-the-eyes-deceive-uncommon-ophthalmic-presentation-of-giant-cell-arteritis","When the Eyes Deceive: Uncommon Ophthalmic Presentation of Giant Cell Arteritis","","Giant cell arteritis (GCA) is a systemic granulomatous large-vessel vasculitis that mainly affects older adults. A rare case is presented of a patient in her 60s with hypertension and isolated cranial nerve (CN) IV palsy. Initial imaging and temporal artery biopsy were negative, with symptom recurrence after prednisolone was stopped. Steroid re-commencement rapidly resolved visual symptoms and headaches within days. The report emphasizes prompt clinical judgement and timely steroid therapy, plus a gradual, prolonged taper to prevent visual loss.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/when-the-eyes-deceive-uncommon-ophthalmic-presentation-of-giant-cell-arteritis/408011/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/when-the-eyes-deceive-uncommon-ophthalmic-presentation-of-giant-cell-arteritis/408011.png","ImageObject",300,407,{"name":92,"@type":93},"Kurz","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the unusual presentation described in this GCA case?","Question",{"text":112,"@type":113},"The patient initially presented with hypertension and isolated cranial nerve (CN) IV palsy, a form rarely reported in giant cell arteritis.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why were the initial diagnostic tests important in this case?",{"text":117,"@type":113},"Initial imaging and temporal artery biopsy were negative, showing that GCA can still present with misleading early results and may require clinical judgement.",{"name":119,"@type":110,"acceptedAnswer":120},"What happened after prednisolone was stopped and then restarted?",{"text":121,"@type":113},"Symptoms resurfaced after prednisolone was stopped; restarting steroids led to quick resolution of visual symptoms and headaches within days.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},408011,1790741472,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},2336478945635,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Review began 11/10/2025  \nReview ended 11/19/2025  \nPublished 11/30/2025  \n© Copyright 2025  \nYap et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98164  \nOpen Access Case Report  \nWhen the Eyes Deceive: Uncommon Ophthalmic Presentation of Giant Cell Arteritis  \nTony Yap 1, Leena Yalakki-Jagadeesh 2, Alison Penwarden 3, Khushbakht Subhani 1  \n1. General Medicine, Basingstoke and North Hampshire Hospital, Basingstoke, GBR 2. Rheumatology, Basingstoke and North Hampshire Hospital, Basingstoke, GBR 3. Ophthalmology, Basingstoke and North Hampshire Hospital, Basingstoke, GBR  \nCorresponding author: Tony Yap, [tonyyap97.77@gmail.com](tonyyap97.77@gmail.com)  \nAbstract  \nGiant cell arteritis (GCA) is a systemic granulomatous large vessel vasculitis that predominantly affects older adults. We present a rare case of a patient in her 60s who presented with hypertension and isolated cranial nerve (CN) IV palsy. Initial imaging and temporal artery biopsy performed were negative. Her symptoms then resurfaced again after her prednisolone was stopped. Re-commencement of steroids led to a quick resolution of her visual symptoms and headaches within a matter of days.  \nThis case highlights the importance of clinical judgement and prompt initiation of steroids without delay. A gradual and prolonged steroid tapering regime is also essential to avoid visual loss, the most feared complication in GCA.  \nCategories: Rheumatology, Ophthalmology  \nKeywords: 4th cranial nerve palsy, anterior ischaemic optic neuropathy, gca, giant cell arteritis (gca), large vessel vasculitis and gca  \nIntroduction  \nGiant cell arteritis (GCA) is a systemic granulomatous vasculitis that predominantly affects older adults [1] . It primarily involves large and medium-sized arteries, particularly the branches of the external carotid artery, such as the temporal artery. Its classical symptoms include headaches, reduced or loss of visual acuity and jaw claudication, corresponding to the supplying arteries that are affected. Whilst diplopia is a specific indicator for GCA with cranial nerve (CN) III involvement, CN IV involvement is rarely described [1] . Visual loss, the most feared complication, usually results from arteritic anterior ischaemic optic neuropathy (AAION), occurring in up to 20% of untreated patients [2] .  \nSystemic symptoms may not always present in GCA, at times only with visual signs and symptoms as described as occult GCA [3] . CN involvement in GCA is rare and typically affects CN III or VI [4,5] . Isolated CN IV palsy has been reported only once in the literature [6] . Temporal artery biopsy remains the gold standard for diagnosis but is subject to false-negatives due to skip lesions [7] . Early diagnosis and treatment are essential, as delayed therapy can result in permanent visual impairment [1,7] .  \nWe present a rare case of GCA initially manifesting as isolated CN IV palsy and delayed recurrence manifesting as AAION.  \nCase Presentation  \nWe present a 67-year-old lady with a background of right knee meniscal tear, shingles, and psoriasis. She is fully independent and physically active, with no personal or family history of autoimmune or early cardiovascular disease. She is a non-smoker.  \nFirst presentation  \nShe initially presented with a hypertension of 185/100 mmHg and a one-day history of sudden-onset binocular vertical diplopia, accompanied by right retro-orbital pain and nausea worsened by eye movement. She had to patch her right eye to manage her diplopia. She also described intermittent, dull right orbital and jaw pain, occurring twice weekly for approximately 20 minutes. Similar, milder episodes had occurred four months earlier and had self-resolved. The pain improved with paracetamol, and nausea was exacerbated","cbCaitKh3NzK0DIC","https://ap.wps.com/l/cbCaitKh3NzK0DIC","pdf",4795459,"English","# Abstract\n# Introduction\n# Case Presentation\n## First presentation\n## Investigation","[{\"question\":\"What is the unusual presentation described in this GCA case?\",\"answer\":\"The patient initially presented with hypertension and isolated cranial nerve (CN) IV palsy, a form rarely reported in giant cell arteritis.\"},{\"question\":\"Why were the initial diagnostic tests important in this case?\",\"answer\":\"Initial imaging and temporal artery biopsy were negative, showing that GCA can still present with misleading early results and may require clinical judgement.\"},{\"question\":\"What happened after prednisolone was stopped and then restarted?\",\"answer\":\"Symptoms resurfaced after prednisolone was stopped; restarting steroids led to quick resolution of visual symptoms and headaches within days.\"}]","When the Eyes Deceive: Uncommon Ophthalmic Presentation of Giant Cell Arteritis | PDF",1790577662,23]