Giant Cell Arteritis of the Superior Mesenteric Artery Presenting With Wernicke Encephalopathy From Thiamine Deficiency

Objective N/A. Background Giant cell arteritis (GCA) is one of the most common systemic vasculitides in adults over age 50 with incidence ranging from 15 to 35 per 100,000 individuals. The disorder often included differential diagnosis maladies producing atypical facial pain, headache, visual loss, amaurosis fugax, jaw elevated inflammatory markers, and anemia. GCA typically known affect cranial arteries physical exam findings tenderness palpation temporal neuropathies. Clinical further supported by new artery abnormality, ESR (= mm/h), abnormal biopsy. Design/Methods Results A 68-year-old female history primary generalized seizures presented clinic a 6-week paroxysms acute confusional episodes, inability arise seated position due lower extremity weakness bilaterally, alterations consciousness without loss consciousness, severe anorexia, weight loss. MRI contrast including Axial FLAIR/T2/Diffusion revealed bilateral pan-lobar cortical subcortical atrophy ex-vacuo ventriculomegaly mild leukoaraiosis white matter tracts. PET-CT body linear uptake involving aortic root, extending into subclavian bilaterally segmental involvement proximal carotids, inferiorly level iliac mesenteric arteries. Temporal biopsy presence granulomas multinucleated giant cells. Serology panel pan hypovitaminoses Vitamins A, B1, B6, B12, D. Conclusions Traditional workup initially resulted inconclusive for patient, whose condition deteriorated as patient's altered mental status dizziness spells continued unremittingly. This case highlights link between large vessel vasculitis malabsorption syndromes, superior artery, medium sized vessel, previously unrecognized. Furthermore, this superb example multiple etiologies treatable causes reversible dementia.