Temporal arteritis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
===[[Headache]]=== | |||
{{Headache DDX}} | {{Headache DDX}} | ||
===Noninflamed Vision Loss=== | |||
{{Acute vision loss noninflamed DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 13:39, 14 October 2014
Background
- Systemic vasculitis involving medium-sized arteries in the carotid circulation
- Pts >50yr
- Can cause painless, ischemic optic neuropathy w/ severe vision loss if left untreated
- Assoc w/ polymyalgia rheumatica
Clinical Features
- Headache
- Jaw claudication
- Myalgias
- Fever
Differential Diagnosis
Headache
Headache
Common
Killers
- Meningitis/encephalitis
- Myocardial ischemia
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Giant cell arteritis of temporal artery (temporal arteritis)
- Idiopathic intracranial hypertension (Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
- Carotid artery dissection
Others
- Mild traumatic brain injury
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Tuberculosis
- Lyme disease
- Syphilis
- Leptospirosis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
Noninflamed Vision Loss
Acute Vision Loss (Noninflamed)
- Painful
- Arteritic anterior ischemic optic neuropathy
- Optic neuritis
- Temporal arteritis†
- Painless
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Posterior reversible encephalopathy syndrome (PRES)
- Retinal detachment†
- Stroke†
- Vitreous hemorrhage
- Traumatic optic neuropathy (although may have pain from the trauma)
†Emergent Diagnosis
Diagnosis
- Temporal artery tenderness
- Afferent pupillary defect
- ESR ~70-110
- CRP elevated
Treatment
- Methylprednisolone 1000mg IV QD x3d
See Also
Source
Tintinalli