A case of Horton's disease (with its potential neurological symptoms) depicted in a portrait by Andrea Mantegna

Excerpt

The painting “Portrait of a Man in Profile” (Fig. 1), attributed to the painter Andrea Mantegna (1431–1506) is part of the “Poldi Pezzoli” Museum (Milan). It shows an aged man in a lateral pose whose extremely realistically depicted traits immediately capture the onlooker’s attention. In particular, the windy turgidity of the temporal artery may suggest that the subject suffered from Horton's disease (also known as giant-cell arteritis), a condition which typically affects patients over 50, principally causing neurological symptoms such as headache as well as being associated to systemic symptoms such as fever and discomfort, polymyalgia rheumatica, visual loss—more specifically blindness—being its most severe complication [1]. Besides headache, neurological symptoms may include neuropathies, neuro-otologic syndromes, tremor, neuropsychiatric syndromes, TIA/strokes, tongue numbness and myelopathy, as found to occur in a set of patients with biopsy-proven giant-cell (temporal) arteritis [2]. Since Andrea Mantegna used to pay a great deal of attention to pathological conditions in his representations—as shown in the depiction of rickets in the young offspring of the Gonzaga family in the Camera degli Sposi in the Mantua Ducal Palace [3]—it is reasonable to think that, while in the act of portraying an old man with the traditional attributes of humanistic gravitas, he may have not neglected to paint an objectively patent pathological trait.

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