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Disorders of Circulation of the Cerebrospinal Fluid
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Other causes of optic disc swelling or involvement of the optic disc should be considered: Optic disc drusen.Optic neuritis.Central retinal vein occlusion.Temporal arteritis.Ischemic optic neuropathy.
Face
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
SMALL PRINT: X-ray of TMJ, temporal artery biopsy, sialogram, CT/MRI scan. FBC: WCC and ESR/CRP raised in infection; ESR/CRP raised in temporal arteritis and tumour (ESR more useful than CRP in suspected temporal arteritis).X-rays: Sinus X-ray of little help in acute sinusitis but may help in chronic pain to assess for possible chronic sinusitis or tumour; TMJ views and dental plain film for abscess likely to be arranged by dentist; parotid sialogram for stone/tumour.Temporal artery biopsy: May be necessary to clinch diagnosis of temporal arteritis.CT/MRI scan the only practical way to examine the posterior cranial fossa and Gasserian ganglion – a specialist investigation.
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.
Chest discomfort leading to the diagnosis of pulmonary artery aneurysm due to isolated main pulmonary arteritis involving giant cells: a case report
Published in Acta Chirurgica Belgica, 2023
Sarah Sakalihasan, Vincent Tchana-Sato, Audrey Courtois, Jean Olivier Defraigne, Natzi Sakalihasan
In this report, the histopathological analysis of the resected PAA revealed vasculitis with multiple multinucleated giant cells. Given the absence of symptoms and clinical signs of temporal arteritis (Horton’s disease) and the normal inflammatory markers, no temporal artery biopsy was performed. Moreover, tissue genetic analysis revealed no coding gene mutations for connective tissue disorders that may explain the aneurysm. The differential diagnosis of GCA from Takayasu arteritis might be difficult by pathological findings alone. In fact, inflammatory infiltrates of lymphocytes, giant cells and fibrosis can be found in Takayasu arteritis and GCA. However, inflammation occurs primarily in the inner and middle layers of the media in GCA, but the outer layer of the media to the adventitia in Takayasu arteritis [6]. Furthermore, Takayasu arteritis predominantly affects the aorta and its major branches in young women; while GCA is primarily a disease of the elderly, affecting middle-to-small sized arteries [2]. In addition, large number of giant cells, as well as granulomatous changes are typically found in GCA [2,6]. Therefore, in our patient, the diagnosis of PAA due to isolated PA vasculitis involving giant cells was made.
The Usefulness of the Erythrocyte Sedimentation Rate and C-reactive Protein for the Differential Diagnosis of Non-Arteritic Anterior Ischemic Optic Neuropathy in the Era of Microinflammation
Published in Ocular Immunology and Inflammation, 2022
Dafna Yaacobi (Shilo), Einor Ben Assayag, Shlomo Berliner, Hila Saranga, Lotan Shilo, Anat Kesler
The diagnosis of NAAION is based mainly on clinical information physical findings and the exclusion of an inflammatory response that exists in patients suffering from arteritis. It is obvious that in part of the patients, the values of the inflammatory biomarkers are of borderline significance due to the fact that multiple risk factors and conditions related to NAAION are by themselves accompanied by a low grade and smoldering inflammation. Thus, it is not uncommon to find clinicians who start corticosteroids in borderline situation until GCA can be excluded with relative certainty by bilateral temporal artery biopsy, ultrasound examination and recently also Pet-CT. Therefore, appropriately matched controls might be of help, as clearly shown in our study. The relatively long follow-up in our cohort (a minimum of 2 years) is reassuring since none of the patients developed temporal arteritis. Thus, the present approach could be regarded as a relatively safe one that helps to establish the differentiation between NAAION and GCA.
Clinical features of large vessel vasculitis (LVV): Elderly-onset versus young-onset
Published in Modern Rheumatology, 2021
Satoshi Morinaka, Hiroto Tsuboi, Shinya Hagiwara, Toshiki Sugita, Daiki Tabuchi, Ryota Sato, Taihei Nishiyama, Shota Okamoto, Toshihiko Terasaki, Mizuki Yagishita, Hiroyuki Takahashi, Yuya Kondo, Isao Matsumoto, Takayuki Sumida
Criteria for the classification of GCA were developed by the ACR in 1990 [5] and feature temporal artery abnormalities and an onset age of 50 years or older. Although not included in this classification, 40-60% of GCA cases are associated with polymyalgia rheumatica (PMR) [6]. Involvement of cranial arteries, such as the temporal or carotid arteries, are considered a classical presentation (classical GCA) but if extra-cranial vessels are involved, this is called extra-cranial or large-vessel GCA (LV-GCA) [7]. Because temporal artery involvement is not essential for this classification, LVV developed after age 50 is more likely to be classified as LV-GCA even in the absence of signature clinical features of classical GCA. On the other hand, juvenile temporal arteritis has been found to be fairly rare [8].