Steroid refractory giant cell arteritis with bilateral vertebral artery occlusion and middle cerebellar peduncle infarction

Giant cell arteritis is the most common primary systemic vasculitis in adults aged ≥50 years and peaks in the eighth decade of life. Common symptoms include headache, scalp tenderness and jaw claudication. Elevated acute phase reactants (erythrocyte sedimentation rate and C-reactive protein) are present in >90% of patients. Visual loss is a well-recognised complication, but approximately 2–4% of giant cell arteritis patients experience stroke, most frequently in the vertebrobasilar territory.

Henoch-Schönlein purpura: a rare vasculitis in older adults

Henoch-Schönlein purpura (HSP) is a small vessel vasculitis with immunoglobulin A-dominant immune deposits found in vessel walls. It primarily affects children, is uncommon in adults and often under-recognised in the elderly population due to its rarity in this group. When a purpuric rash develops in an older person it is typically treated with antibiotics for presumed infection, rather than investigated as potentially HSP. It is important to recognise this condition, particularly in older adults, as diagnosis has implications for management and prognosis.