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Giant Cell Arteritis

A Curious Headache

Step 1: View clinicals

An 80 year old woman presents with a constant, left-sided frontal headache for 2 weeks, which she describes as being severe and disturbing. She also experienced an episode of 'blurring of vision' in her right eye yesterday, which spontaneously resolved after a few minutes. Her medical history is significant for hypertension for 10 years, which is well controlled on losartan alone, and osteoarthritis of both knee joints, which is being treated conservatively. Her full blood count, fasting blood glucose, renal functions and electrolytes, and liver functions are within normal parameters.

Step 2: Order all relevant investigations


ESR: 60 mm/1h (< 15) CRP: 12 ng/ml (< 6)

MRI Brain

The MRI scan of the brain appears normal.

Lumbar Puncture

The cerebrospinal fluid analysis is within normal parameters.

Temporal Artery Biopsy

The biopsy results will be available tomorrow.

Step 3: Select appropriate management

IV Methylprednisolone
IV Antibiotics
Neurosurgical Referral
Osteoporosis Prophylaxis

Score: ★★☆