Giant Cell Arteritis Presenting as Isolated Abducens Nerve Palsy

Giant cell arteritis (GCA) is a granulomatous vasculitis affecting medium to large-sized arteries with frequent involvement of branches of the carotid artery. It is the most common form of vasculitis in older adults (> 50 years) and predominantly affects females. Cranial nerve sixth palsy is not uncommon but is usually due to microvascular ischemic insult rather than GCA. GCA typically presents with either systemic or ocular manifestations. Ocular manifestations include ophthalmoplegia due to cranial nerve palsy or vision loss due to retinal or optic nerve ischemia. We aim to highlight two cases of GCA that presented with cranial nerve VI (CNVI) palsy which is a relatively uncommon presentation.