The involvement of the peripheral nervous system in biopsy proven active giant cell arteritis

Peripheral nervous system (PNS) affection is an uncommon, sometimes life-threatening manifestation of giant cell arteritis (GCA). To describe characteristics of neurological abnormalities of the PNS in GCA patients. Eighty consecutive cases of biopsy proven GCA were studied. Three patients presented with subacute sensorimotor deficits abnormalities in the distribution of the arm plexus. In all cases PNS affection was the leading clinical symptom in addition to a typical clinical syndrome of cranial arteriitis. In one case MRI demonstrated diffuse signal abnormalities surrounding the brachial nerve plexus. In another patient, who died from pulmonary embolism 10 weeks after beginning of therapy, autopsy demonstrated residual arteritis in an artery supplying the brachial nerve plexus. Involvement of the PNS is more uncommon than cerebral ischemia and neuroophthalmological complications in patients suffering from GCA. Severe PNS involvement has an affinity to the midcervical nerve roots and the brachial nerve plexus.