Diseases of Blood vessels
P. Chopra, R. Ray, A. Saxena in Illustrated Textbook of Cardiovascular Pathology, 2013
Temporal arteritis occurs in elderly individuals generally over the age of 50 years affecting women more often than men. Amongst the extracranial arteries temporal artery is most commonly involved. Headache and throbbing pain in the temporal region is a common presentation. Other features include scalp tenderness, polymyalgia, fever, malaise and visual symptoms. Anemia and raised erythrocyte sedimentation rate are commonly associated. Microscopically, it is characterized by panarteritis with infiltration by lymphocytes, plasma cells, macrophages, epithelioid cells and occasional eosinophils. Inflammatory cell infiltration is most marked in the media. Internal elastic lamina is fragmented and giant cell reaction in relation to it is frequently observed. Intima is thickened leading to narrowing of the lumen (Figs 13.21 and 13.22). Etiology is unclear. Both humoral and cell-mediated immunity have been demonstrated. It is also believed that the elastic tissue may excite a local immunological response. Cytokines namely IL-1, IL-6 and tumor necrosis factor have also been implicated in the pathogenesis.
Stroke in young people
Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees in Stroke in Practice, 2017
In contrast to many other vasculitic disorders, temporal arteritis is primarily a condition of the elderly and is very rare in those under 60 years of age. Although almost any vessel can be affected, there is a predeliction for the ophthalmic artery and the branches of the external carotid artery. Accordingly, patients with temporal arteritis may present to stroke services with monocular blindness. There should be a low index of suspicion for temporal arteritis in all elderly patients with transient monocular blindness as prompt identification and treatment may prevent progression to permanent visual loss. Associated features may include tenderness over the temporal arteries and evidence of ischaemia in the territory supplied by the external carotid artery, with claudication of the jaw being the best-recognised clinical manifestation. Definitive diagnosis is by temporal artery biopsy, which reveals patchy granulomatous inflammation. ESR is usually markedly elevated, and liver function tests may be mildly deranged. Features of the related condition giant cell arteritis (fatigue, proximal muscle weakness, and stiffness) may also be present. As the condition may progress rapidly with the prospect of permanent visual loss, treatment with high dose corticosteroids is recommended before a definitive pathological diagnosis is obtained.
Face
Keith Hopcroft, Vincent Forte in 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.
Associations among temporal and large artery abnormalities on vascular ultrasound in giant cell arteritis
Published in Scandinavian Journal of Rheumatology, 2021
MA DiIorio, PS Sobiesczcyk, C Xu, W Huang, JA Ford, SS Zhao, DH Solomon, WP Docken, SK Tedeschi
The historical name for GCA – temporal arteritis – reflects the concept of this disease as a disease of the temporal arteries. In the past decade, advanced imaging modalities have broadened the appreciation of GCA as a systemic vasculitis that also involves the aorta and its branches in at least 40–50% of patients (6–10). Previous larger studies investigating patterns of vascular involvement in GCA using magnetic resonance angiography (MRA) and positron emission tomography–computed tomography (PET-CT) were not able to evaluate relationships between temporal and large arteries because they did not visualize the temporal arteries (11–13). [Several reports have indicated that this limitation can be overcome for both modalities with updated technology (14–16).] A small number of studies employing VUS have found that some GCA patients have predominantly temporal artery involvement, while others have predominantly large artery involvement that is usually bilateral (17–20). Other reports of VUS and GCA have commented on disease distribution, but did not evaluate correlations between individual arteries (18, 20–24). Some studies correlating symptoms and involved vessels focused on a small number of arteries (e.g. superficial temporal, vertebral, or occipital arteries), so their conclusions were perforce limited to those vessels (25–28).
Ocular Involvement in Systemic Lupus Erythematosus: The Experience of Two Tertiary Referral Centers
Published in Ocular Immunology and Inflammation, 2018
Rosanna Dammacco, Pasquale Procaccio, Vito Racanelli, Angelo Vacca, Franco Dammacco
The second patient experienced a central retinal artery occlusion (CRAO), an emergency condition that is considered the ocular analogue of cerebral stroke52 and has been described as possible initial manifestation of SLE.45,53 At the time of the first diagnosis of a severely active SLE, she complained of headache and dizziness associated with rapidly increasing, painless vision loss in her right eye, which eventually resulted in hand motion as BCVA. No signs and symptoms of giant cell arteritis of the temporal artery (such as fever, malaise, temporal tenderness, jaw claudication, shoulder and pelvic girdle pain) were present. Fundus examination was normal in the left eye, whereas retinal artery attenuation and whitening of the retina with a cherry-red spot in the fovea were observed in the right eye. SD-OCT of the same eye revealed marked edema of the macula and a delay in arterial filling at the early to late phase, but no emboli were detected by FFA. Cherry-red spots and a ground-glass retina became visible the next morning.
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.
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