This little known but not so rare condition can have a devastating impact on patient’s lives if warning signs are missed. Undiagnosed or untreated, Giant Cell Arteritis (GCA) can cause serious problems including permanent vision loss.
I represented Mrs F, an 89 year old lady, in a clinical negligence claim regarding the failure to diagnose GCA. Mrs F had symptoms of GCA including headaches, nausea, fatigue and visual disturbances. She attended her GP on a number of occasions and was referred to hospital twice for investigation over a six week period. The condition was not diagnosed and Mrs F suffered total loss of vision. Although she was prescribed a course of steroids, the damage was irreversible and her sight could not be saved. Mrs F, who was previously an independent 89 year old, now needs 24-hour care and support.
The hospital admitted liability and sent a letter of apology to Mrs F. A six-figure settlement was reached.
What is Giant Cell/Temporal Arteritis?
GCA is a condition which causes inflammation on the inside of some blood vessels (arteries). This inflammation causes the arteries to narrow, impeding adequate blood flow. One of the areas that is affected is the temporal artery, on the side of the head, leading to the eye (specifically known as temporal arteritis).
What are the signs of GCA?
Those affected by GCA are almost exclusively over 50 years old and are often women. National Instititute of Health and Care Excellence (NICE) guidance states that symptoms include:
- Localised headaches
- Scalp tenderness in approximately 50% of people
- Pain in the jaw when eating in approximately 50% of people
- Systematic features such as fatigue
- Neurological features occur in about 30% of people and include transient ischaemic attack or stroke
- Visual disturbances including permanent, partial or complete loss of vision in one or both eyes occurs in up to 20% of people including:
- A feeling of shade covering one eye
- Double vision and visual field defects
- Untreated, the second eye is likely to become affected within 1-2 weeks although it can be affected within 24 hours
- Once visual impairment is established, it is usually permanent
Diagnosis and Treatment
If a patient has the above symptoms, they should be treated as a medical emergency. Patients should be started on steroids to reduce inflammation and prevent blood supply to the arteries from becoming blocked whilst further tests are undertaken to confirm the diagnosis.