Temporal arteritis
Revision as of 23:34, 30 January 2016 by Neil.m.young (talk | contribs)
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
- Associated with polymyalgia rheumatica (30-40%)[1]
Clinical Features
American College of Rheumatology Criteria[2]
- 3 or more criteria 93% sensitive and 91% specific
- Age ≥ 50 years old
- New onset of headache
- Temporal artery tenderness or decreased pulse
- ESR ≥ 50 mm/hr
- Artery biopsy with necrotizing arteritis or a granulomatous process with multinucleated giant cells
Differential Diagnosis
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
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
- 84% sensitivity, 30% specificity[3]
- >15% of patients can have a normal ESR
- CRP elevated
- 4% of patients have normal CRP and ESR with biopsy confirmed dx[4]
Treatment
- Methylprednisolone 1000mg IV QD x3d
- Needs temporal artery biopsy
Disposition
- Admission
See Also
Source
- ↑ 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.
- ↑ Hunder GG. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990; 33(8):1122-8
- ↑ Kermani TA, et al. Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis. Semin Arthritis Rheum. 2012; 41:866–871.
- ↑ Jhun P, et al. Giant Cell Arteritis: Read the Fine Print! Ann Em Med. 2015; 65(5):615–617.