Temporal Arteritis

Cardiovascular

Clinicals - History

Fact Explanation
Commonly occurs in persons over 50 years of age. The inflammatory process starts with the formation of foreign body giant cells which attack focal calcifications in the arterial internal elastic membrane. These calcifications increase with age . Commonly occurs in persons over 50 years of age.
The inflammatory process starts with the formation of foreign body giant cells which attack focal calcifications in the arterial internal elastic membrane. These calcifications increase with age .
Headache, localized mainly to the temporal or occipital regions. Due to the occlusive luminal hyperplasia associated with the chronic vasculitis of the cranial vessels originating from the aortic arch . Headache, localized mainly to the temporal or occipital regions.
Due to the occlusive luminal hyperplasia associated with the chronic vasculitis of the cranial vessels originating from the aortic arch .
Scalp tenderness (eg: when combing hair). Due to vessel wall inflammation of the exracranial branches of the carotid arteries . Scalp tenderness (eg: when combing hair).
Due to vessel wall inflammation of the exracranial branches of the carotid arteries .
Jaw claudication. Due to vascular insufficiency of the muscles of mastication . Jaw claudication.
Due to vascular insufficiency of the muscles of mastication .
Amaurosis fugax. It is a prodromal signal of central retinal artery occlusion which can then result in permanent loss of vision . Amaurosis fugax.
It is a prodromal signal of central retinal artery occlusion which can then result in permanent loss of vision .
Reduced vision. Reduced visual acuity can occur when the vasculitis occurs in the posterior ciliary artery which supplies the optic nerve head . Reduced vision.
Reduced visual acuity can occur when the vasculitis occurs in the posterior ciliary artery which supplies the optic nerve head .
Fever and malaise. Due to the systemic inflammatory response associated with the vasculitis . Fever and malaise.
Due to the systemic inflammatory response associated with the vasculitis .

Clinicals - Examination

Fact Explanation
Tortuous, thickened superficial temporal artery that is tender on palpation with loss of pulsation. Due to degradation of the internal elastic lamina of the vessel wall followed by occlusive luminal hyperplasia . Tortuous, thickened superficial temporal artery that is tender on palpation with loss of pulsation.
Due to degradation of the internal elastic lamina of the vessel wall followed by occlusive luminal hyperplasia .
A swollen and pale optic disc on fundoscopy. Due to occlusion of the posterior ciliary artery (which supplies the optic nerve head) as a result of the vasculitis . A swollen and pale optic disc on fundoscopy.
Due to occlusion of the posterior ciliary artery (which supplies the optic nerve head) as a result of the vasculitis .
Ischemic changes in the retina on fundoscopy. Due to central retinal artery occlusion . Ischemic changes in the retina on fundoscopy.
Due to central retinal artery occlusion .
Reduced visual acuity, visual field defects and abnormalities noted during slit lamp examination of the eye. Due to posterior ciliary artery occlusion resulting in infarction and damage to the optic nerve head, and central retinal artery occlusion resulting in retinal ischemia . Reduced visual acuity, visual field defects and abnormalities noted during slit lamp examination of the eye.
Due to posterior ciliary artery occlusion resulting in infarction and damage to the optic nerve head, and central retinal artery occlusion resulting in retinal ischemia .
Cranial nerve palsies. Due to the vasculitis affecting the arteries that supply specific cranial nerves . Cranial nerve palsies.
Due to the vasculitis affecting the arteries that supply specific cranial nerves .

Investigations - Diagnosis

Fact Explanation
Markedly elevated erythrocyte sedimentation rate (ESR). Due to the intense acute phase response. . Markedly elevated erythrocyte sedimentation rate (ESR).
Due to the intense acute phase response. .
Elevated CRP levels. It is an acute phase protein . Elevated CRP levels.
It is an acute phase protein .
Superficial temporal artery biopsy. It's a confirmatory test where histopathological findings prove the presence of vasculitis . Superficial temporal artery biopsy.
It's a confirmatory test where histopathological findings prove the presence of vasculitis .

Investigations - Management

Fact Explanation
ESR levels. To assess respose to steroid treatment and detect relapses . ESR levels.
To assess respose to steroid treatment and detect relapses .
Fasting blood glucose levels. For the early detection of diabetes mellitus which could occur as a complication of long term steroid treatment . Fasting blood glucose levels.
For the early detection of diabetes mellitus which could occur as a complication of long term steroid treatment .
Vascular Magnetic Resonance Imaging (MRI) studies. To screen for vasculitis affecting the aorta which could in turn lead to fatal aortic dissection and aneurysmal rupture . Vascular Magnetic Resonance Imaging (MRI) studies.
To screen for vasculitis affecting the aorta which could in turn lead to fatal aortic dissection and aneurysmal rupture .

Management - Specific

Fact Explanation
High dose Corticosteroids (60-100mg daily). Their role as anti-inflammatory agents give corticosteroids the ability of controlling clinical manifestations and preventing ischemic complications of temporal arteritis . It should be noted that symptomatic improvement usually occurs about 72 hours after the initiation of steroids. High dose Corticosteroids (60-100mg daily).
Their role as anti-inflammatory agents give corticosteroids the ability of controlling clinical manifestations and preventing ischemic complications of temporal arteritis . It should be noted that symptomatic improvement usually occurs about 72 hours after the initiation of steroids.
Immunosuppressants such as methotrexate. Considered as adjuvant therapy when either recurrent relapses occur or there is failure to wean corticosteroid dose . Immunosuppressants such as methotrexate.
Considered as adjuvant therapy when either recurrent relapses occur or there is failure to wean corticosteroid dose .
Calcium suppliments and vitamin D. To prevent osteoporosis which is a complication of long term corticosteroid treatment . Calcium suppliments and vitamin D.
To prevent osteoporosis which is a complication of long term corticosteroid treatment .

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