SCALP NECROSIS WITH GIANT-CELL ARTERITIS

Objective: Giant cell arteritis (GCA) often presents with devastating visual loss in the elderly, yet early diagnosis and treatment can prev ent visual loss. The authors report two cases of GCA in which scalp ne crosis, a rare finding not reported previously in the ophthalmic liter ature, played an important role in diagnosis. Design: Observational ca se reports and literature review. Participants: Two patients with GCA had scalp necrosis, Intervention: Intravenous steroid administration w as performed. Main Outcome Measure: Vision and healing of scalp necros is were measured. Results: One patient had scalp necrosis that was dia gnosed incorrectly preceding visual loss. Another patient had visual l oss in one eye diagnosed as nonarteritic anterior ischemic optic neuro pathy, He had scalp necrosis develop 2 weeks later, leading to the cor rect diagnosis of GCA, There are 21 previously reported cases of scalp necrosis with GCA, none in the ophthalmic literature, most of which w ere undiagnosed until the onset of visual loss. In addition, a higher rate of visual loss is seen in GCA with scalp necrosis. Conclusions: S calp necrosis is a valuable sign that frequently is misdiagnosed until visual loss occurs, In addition, it may indicate a more severe vascul itis, This finding should be added to the list of signs evaluated in p atients for whom GCA is in the differential diagnosis.