Clin Med
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A 65-year-old Caucasian woman presented to the emergency department with rapidly worsening shortness of breath. On presentation she was tachycardic and tachypnoeic with reduced (85%) oxygen saturation. Cardiovascular examination revealed elevated jugular venous pressure with positive Kussmaul's sign, pulsus paradoxus and muffled heart sounds. ⋯ She subsequently underwent aortic root and aortic valve replacement surgery. Histology of the resected specimen showed inflammatory infiltrate with giant cell formation indicative of giant cell arteritis (GCA). This case highlights the need to consider GCA in the differential diagnosis of patients presenting with aortic aneurysm and pericardial effusion.
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We describe the case of a woman who presented with seemingly non-specific symptoms, including collapse, but through examination was eventually revealed to have an unusual, potentially fatal, but treatable neurological condition. We share some thoughts on the process of diagnosis, the difficulty of diagnosing a rare disease and the practice of neurology on the acute medical take. We also highlight the value of screening neurological examination in acute medical patients.