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Giant cell arteritis (GCA) is an immune-mediated vasculitis with intra and extracranial involvement commonly seen in the elderly population. However, a subgroup of patients may present with constitutional symptoms only called “masked GCA.” We diagnosed and successfully treated a patient who initially presented with cachexia, cognitive impairment, and seizure. Clinicians need to be very suspicious about the entity, as a miss can lead to life-threatening complications such as stroke, arterial dissection, and even aneurysm rupture (besides visual impairment). Although GCA involves medium and large vessels, small vessel vasculitis is also possible in GCA (as in our case). Hence, GCA may involve patients in their fifties and may present with a wide spectrum of intracranial and extracranial clinical manifestations.