Temporal arteritis: Difference between revisions
No edit summary |
|||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Giant cell arteritis | |||
*Systemic vasculitis involving medium-sized arteries in the carotid circulation | *Systemic vasculitis involving medium-sized arteries in the carotid circulation | ||
* | *Women | ||
*50-70 yrs typically | |||
*Can cause painless, ischemic optic neuropathy w/ severe vision loss if left untreated | *Can cause painless, ischemic optic neuropathy w/ severe vision loss if left untreated | ||
*Assoc w/ polymyalgia rheumatica | *Assoc w/ polymyalgia rheumatica (30-40%)<ref> Lehrmann JF, Sercombe CT: Systemic Lupus Erythmatosus and the Vasculitides, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 116: p 1497-1510.</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
*Headache | *Fever | ||
Headache | |||
*Jaw claudication | *Jaw claudication | ||
**Weight Loss | |||
*Myalgias | *Myalgias | ||
* | *Visual loss in one eye | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 26: | Line 30: | ||
==Treatment== | ==Treatment== | ||
*Methylprednisolone 1000mg IV QD x3d | *Methylprednisolone 1000mg IV QD x3d | ||
*Needs Temporal Artery Bx | |||
==See Also== | ==See Also== | ||
| Line 31: | Line 36: | ||
==Source== | ==Source== | ||
Tintinalli | *Tintinalli | ||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
[[Category:Rheum]] | [[Category:Rheum]] | ||
Revision as of 14:57, 24 January 2015
Background
- Giant cell arteritis
- Systemic vasculitis involving medium-sized arteries in the carotid circulation
- Women
- 50-70 yrs typically
- Can cause painless, ischemic optic neuropathy w/ severe vision loss if left untreated
- Assoc w/ polymyalgia rheumatica (30-40%)[1]
Clinical Features
- Fever
Headache
- Jaw claudication
- Weight Loss
- Myalgias
- Visual loss in one eye
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
- Needs Temporal Artery Bx
See Also
Source
- Tintinalli
- ↑ Lehrmann JF, Sercombe CT: Systemic Lupus Erythmatosus and the Vasculitides, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 116: p 1497-1510.