Abstract Introduction Ischemic strokes are a significant cause of mortality and classified by etiology: cardioembolic, small vessel occlusion, large artery atherosclerosis, of undetermined etiology, or other determined etiology. The onset of neurological deficits necessitates investigation and treatment. We present a case of a 58-year-old male with an acute ischemic stroke of undetermined etiology that resulted in granulomatosis with polyangiitis (GPA). Description A 58-year-old male with chronic rhinosinusitis post-septoplasty, essential tremor, and pituitary apoplexy with partial resection presented to the ED with severe myalgias, generalized headache, and sudden truncal instability. Previously, he experienced eye redness, bilateral headaches, and severe myalgias. His primary care provider prescribed oral steroids, which temporarily improved his symptoms. His inability to sit up prompted his ED visit. Physical examination revealed muscle tenderness, positive Romberg, and positive Babinski in the left foot. Initial workup- blood cultures, CPK, aldolase, CMP, UA, CBC, HIV, Hepatitis profile, lipid profile, toxicology, glycated Hgb, COVID-19, Influenza, and hormonal tests- was unremarkable except for an elevated ESR of 101 and CRP of 258. Head CT, echocardiography, telemetry, and carotid doppler were normal. MRI showed an ischemic lacunar stroke in the basal ganglia. Rheumatology, Neurology, and Ophthalmology were consulted. A temporal artery biopsy was negative. He received Dexamethasone 6 mg IV, resulting in slight symptomatic improvement, and was discharged with Prednisone 20 mg for follow-up. Outpatient workup revealed 1:80 C-ANCA titers, RF titers of 89, PR-3 levels of 8, increased SCr, and severe proteinuria. Prednisone was increased to 40 mg, and he was referred for a kidney biopsy. The biopsy confirmed the diagnosis of GPA. High-dose steroids and cyclophosphamide were initiated, leading to gradual improvement, regaining the ability to stand and walk with assistance. Discussion About 50% of patients with GPA experience neurological symptoms, though CNS involvement is rare. Vasculitis should be considered in ischemic stroke patients with high inflammatory markers and no common risk factors. A high level of clinical suspicion is essential for diagnosing and treating such conditions effectively. This abstract is funded by: None
Cruz et al. (Fri,) studied this question.