Bilateral Optic Sheath Enhancement in Giant Cell Arteritis (GCA) Presenting With Occipital Neuralgia-Like Symptoms

We present the case of an 86-year-old woman admitted with a two-week history of a bilateral occipital burning sensation, without fever, jaw claudication, or neck stiffness. Laboratory investigations revealed a markedly elevated C-reactive protein (CRP) level of 284 mg/L. Magnetic resonance imaging (MRI) of the head with contrast demonstrated bilateral hyperenhancement of the optic nerve sheaths. Although optic nerve signal changes are an uncommon manifestation of giant cell arteritis (GCA), the neurology team commenced high-dose oral prednisolone (60 mg once daily), considering GCA in the differential diagnosis. The patient showed rapid symptomatic and biochemical improvement following steroid initiation. Subsequent temporal artery ultrasound findings were consistent with GCA, supporting the diagnosis. This case highlights an unusual radiological presentation of GCA and underscores the importance of early empirical treatment to prevent irreversible visual complications.