Transient ischaemic attack in a patient with known temporal arteritis: a case report

INTRODUCTION: Older populations are more at risk of problems such as temporal arteritis or polymyalgia rheumatica, and these conditions are often first diagnosed in general practice, with usual ongoing care and long-term treatment with oral steroids. These inflammatory conditions are also potential risk factors for other complicating presentations such as transient ischaemic attacks, but the precise comorbid links and how these might influence clinical management in general practice are unclear. CASE PRESENTATION: An 82-year-Caucasian woman living alone requested a home visit after a single episode of speech disturbance and disorientation which lasted 15 minutes. This occurred 2 weeks after cessation of her oral prednisolone for temporal arteritis, which was clinically diagnosed in 2006 and later confirmed by a biopsy. She also had a past medical history of ischaemic heart disease based on symptom presentation and an abnormal ECG in October 2005, but no other relevant risk factors for cardiovascular disease. CONCLUSIONS: Transient ischaemic attack is an alternative presentation or complication of an inflammatory disease such as temporal arteritis. The clinical implications of this case relate to the assessment of comorbid risk in TA and in tailoring the drug treatment. In using prednisolone treatments in such patients, general practitioners will need to carefully titrate drug doses and the duration of treatment to prevent complications. Clear evidence for the precise type of management remains to be established.