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Practice paper
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Temporal arteritis often presents with headache and temporal artery tenderness. Other symptoms may include jaw claudication and visual disturbance. The main concern is irreversible blindness, which may occur in both eyes, and therefore requires a high index of suspicion. If temporal arteritis is suspected, an ESR should be requested, the patient should be started on steroids and a temporal artery biopsy should be performed within the next few days. This often confirms the diagnosis, but skip lesions may be seen and a negative biopsy does not rule it out. Most cases settle with steroids within 2 years. There is an association with polymyalgia rheumatica in 25% of cases.
Classification and diagnosis of headache
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Secondary headache disorders often have associated features. Neurological deficits may accompany the headache of organic disease, depending upon the localization of the lesion. Intracranial mass lesions are associated with nausea and vomiting or vomiting (projectile) without nausea in half the cases. Giant cell arteritis may be associated with localized scalp tenderness, malaise, arthralgias or myalgias (polymyalgia rheumatica), low-grade fevers, depression or other constitutional symptoms, and visual disturbances or stroke. Jaw claudication, if present, is virtually pathognomonic for giant cell arteritis. Fever and stiff neck typify the headache of meningitis.
Clinical examination
Published in Nicholas Summerton, Primary Care Diagnostics, 2018
The headache of temporal arteritis is often non-specific in character and it seems that a temporal location only confers a positive likelihood ratio of 1.5 and a tender scalp only 1.6. Jaw claudication is pain in the proximal jaw near the temporomandibular joint that develops after a brief period of chewing (especially for food requiring a lot of mastication such as tough meat) and provides a higher positive likelihood ratio of 4.2. However, no information is available on the reproducibility of this symptom and it must also be distinguished from disorders of the temporomandibular joint where the pain commences immediately on mastication. The presence of diplopia also substantially increases the likelihood of disease (LR+ 3.4). However, it is important to note that the negative likelihood ratios of jaw claudication and diplopia are only 0.7 and 0.9 respectively, indicating that their absence is much less helpful in arguing against the diagnosis of temporal arteritis.
The diagnosis and management of temporal arteritis
Published in Clinical and Experimental Optometry, 2020
Melvin Lh Ling, Jason Yosar, Brendon Wh Lee, Saumil A Shah, Ivy W Jiang, Anna Finniss, Alexandra Allende, Ian C Francis
Jaw claudication occurs in up to 50 per cent of patients with TA and may be misdiagnosed as temporomandibular joint disorder (TMJD).1997 In TA, jaw claudication is caused by masseter muscle ischaemia and is characterised by pain that develops with or soon after chewing, and subsides with rest. In contrast, TMJD causes jaw pain with any movement, emphasising the difference between the mechanical and ischaemic nature of the pain.2009 Patients with jaw claudication often avoid chewy foods or meat, although this is not a distinguishing feature from TMJD.1991 In one study, 54 per cent of patients with positive temporal artery biopsies had jaw claudication compared with only three per cent who had negative biopsies.1995 Asking a patient to chew gum is a simple method of evaluating jaw claudication,2016 but in the absence of chewing gum in the clinic, the authors simply ask the patient to open and close the jaw rapidly and forcefully 20 times. Jaw claudication alone should not be used to rule in TA due to the potential morbidity associated with steroid treatment, as demonstrated in one case by the authors of mandibular osteomyelitis misdiagnosed as TA.2011
Ocular manifestations of giant cell arteritis
Published in Expert Review of Ophthalmology, 2019
David F. Skanchy, Aroucha Vickers, Claudia M. Prospero Ponce, Andrew G. Lee
Clinically, GCA has a broad spectrum of associated symptoms, with the most common being headache (70–90%), jaw claudication (40–60%), transient ischemic attack (4%), neck pain, scalp tenderness (including the temporal artery), and transient or constant visual disturbances (e.g. amaurosis fugax, AION, CRAO, and ophthalmoplegia or diplopia) [3,4,6,7,32,49–52]. Despite the classic presentation of headache and scalp tenderness localized to the temporal region, it may also present diffusely or localize to any part of the head, including the occiput [50]. Jaw claudication, manifesting as pain that increases while chewing, may lead to decreased food intake, weight loss, and weakness [2]. While not sensitive, it is a relatively specific symptom of GCA [2,8,51].
Red Flags in the Assessment of Adult Ophthalmoplegia
Published in Journal of Binocular Vision and Ocular Motility, 2018
Kimberly S. Merrill, Michael S. Lee, Collin M. McClelland
The diagnosis of GCA remains an art predicated upon early clinical suspicion based upon demographics and presenting symptoms. GCA virtually never occurs in patients younger than 50 years and risk increases with age. The diagnosis is especially rare in non-Caucasians. The most common symptoms of GCA include headache, jaw claudication, weight loss, anorexia, neck pain, low grade fever, and scalp tenderness.7 Of these GCA symptoms, jaw claudication is by far the most specific symptom for GCA. Jaw claudication, or exertion-related ischemia, is often not considered painful by patients; thus the optimal screening question for this symptom should be: “Does your jaw get tired or ache when you chew food?” instead of “Do you have jaw pain?”