If not GCA despite symptoms, what might it be?

[Cobalt2sister]

hi...just wondering if anyone has list if possible diagnoses if they decide its not GCA? What might they be thinking? I guess ill find out Thursday doc appt but wanted to be forwarned, review them and think for myself whether I think they fit. Some of my systems classic: temple headache, tender sore scalp, occipital pain, brief visual disturbances but biopsy negative as I know it can be even with GCA. She gas home in the 80 pres til I see her. What might she be considering?? Thanks everyone. Can't sleep so instead sending love and blessings ( and question!) Out to you all.

[SheffieldJane]

I have heard mini strokes and more serious ones mentioned as behaving similarly but my money would be on GCA and the biopsy not being performed at the exact point in the artery that the halo effect cells are. I don’t understand the sentence that begins “She gas home” is it pesky auto correct ?

[Cobalt2sister in reply to SheffieldJane]

Oh I didn't catch that, yes the pesky auto correct thing..should read : she has me on 80 mg pred until i see her! I did have 2 brief mini strokes in august with work up with no visual. If she thought that at all she would have sent me to E R as she did back then. It seems there aren't too many things that mimic GCA, eh? I know I believe it to be GCA but I'm no doctor! Thanks for your input. Stay well

[SheffieldJane in reply to Cobalt2sister]

GCA can be described as a stroke too I think. I would still go to ER with visual symptoms even on 80 mgs. An infusion would contain an even higher dose to safeguard your eyesight.

[jinasc]

Like SJ, I would also head to ER.

[PMRpro Ambassador]

All those symptoms are typical of poor blood flow to the areas. Neck problems can reduce blood flow and one thing that can masquerade as GCA is ankylosing spondylitis - there was a lady on another forum whose symptoms even fooled Prof Dasgupta into thinking she had had GCA, he thought it was no longer active so it was a case of symptom management but only pred helped and he wouldn't let her have enough, She then decided to appeal to Sarah Mackie in Leeds and she took over her care - picking up on her comment that she had bad back pain at night but about 1-2am. This is much earlier than is typical for PMR so Sarah sent her for more extensive imaging - and lo and behold, it WAS ankylosing spondylitis. The inflammation in the neck was casuing swelling that was pinching the arteries.

But the negative biopsy in the presence of typical symptoms is very often ignored as a false negative - they call the TAB a gold standard. It isn't a gold standard, gold standards are always right - TAB has a pretty high failure rate for that!

However, this gives potential differential diagnoses - there is also a patient summary towards the bottom:

uptodate.com/contents/diagn....

And apparently, presence of the chickenpox or shingles virus in the arteries can also cause very similar symptoms!

[Cobalt2sister in reply to PMRpro]

Thanks for all the helpful info!