{'fraction_non_alphanumeric': 0.035869565217391305, 'fraction_numerical': 0.012318840579710146, 'mean_word_length': 5.466042154566745, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 1, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Giant cell arteritis, oculomotor nerve palsy, and acute hearing loss

Giant cell arteritis, also referred to as temporal arteritis or Horton’s disease, is a systemic vasculitis affecting largeand medium-sized arteries. Giant cell arteritis is characterized clinically by fever, anaemia, high erythrocyte sedimentation rate (ESR), and headaches (1, 2). In this letter, we report for the first time a case of histologically proven giant cell arteritis in which two rare clinical manifestations, unilateral third nerve palsy and sensorineural hearing loss, coexisted. An 80-year-old woman was admitted to hospital with a 2-week history of headaches, shooting occipital neck pain, diplopia, and hypoacusia. No past history of diabetes and hypertension was described. Physical examination revealed pupillary dilatation in the left eye, bilateral temporal artery prominence, and stiffness. Visual acuity and fundoscopy were normal. An audiogram revealed complete left-sided hearing loss and rightsided hypoacusia. At admission, tests showed no abnormalities except fibrinogen 456 mg/dL, ESR 44 mm/h (normal valueƒ15 mm/h), and C-reactive protein (CRP) 24 mg/L (normal valueƒ6 mg/L). On the second day ptosis and external strabism of the left eye developed. Because a unilateral oculomotor nerve palsy associated with headache led us to suspect central neurovascular disease, the patient underwent a magnetic resonance angiography (MRA) of the head and neck revealing no abnormalities. On colour duplex ultrasono graphy no fluximetric alterations of the carotid, vertebral, ophthalmic, ciliar, or retinal arteries were seen. We hypothesized a giant cell arteritis and the patient was treated immediately with high-dose corticosteroids (50 mg prednisone daily). After 4 days of corticosteroid treatment the headaches disappeared and tests showed an ESR of 11 mm/h. After 5 days of corticosteroid therapy, a temporal artery biopsy was performed in order to make a definitive diagnosis; the resulting diagnosis was giant cell arteritis of the temporal artery. The patient was discharged after 8 days of hospitalisation with domiciliary therapy of 50 mg corticosteroids/day, pump proton inhibitors, bisphosphonates, calcium, and 1,25-OH-vitamin D for prevention of corticosteroid-induced osteoporosis. Over the following weeks, the patient developed diffuse alopecia without scab ulceration and there was an improvement in her oculomotor nerve palsy. After 1 month, the patient had normal visual acuity, while left pupillary dilatation persisted; an audiogram showed a resolving sensorineural hearing loss to the left Francesco Violi, Division IV Clinical Medicine, University ‘‘La Sapienza’’, Viale del Policlinico, 00161 Rome, Italy. E-mail: francesco.violi@uniroma1.it