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Temporal Arteritis
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Overview

Temporal arteritis, also known as giant cell arteritis, is an inflammatory condition affecting the medium-sized blood vessels that supply the head, eyes, and optic nerves.  The disease usually affects those over 60 years of age and causes the vessels in the temple and scalp to become swollen and tender.  Women are approximately 4 times more likely to suffer from this disease then men. 

The major concern with temporal arteritis is vision loss, although if allowed to progress, it may affect arteries in other areas of the body.  This condition is potentially vision threatening, however, if treated promptly, permanent vision loss can be prevented.  Vision is threatened when the inflamed arteries obstruct blood flow to the eyes and optic nerves.  If untreated, permanent vision loss can occur from oxygen deprivation to the retina and optic nerve.
 
Signs and Symptoms

Patients with temporal arteritis usually notice visual symptoms in one eye at first, but as many as 50% may notice symptoms in the fellow eye within days if the condition is untreated.    

  • Headache

  • Tenderness of scalp (combing hair may be painful)
  • Pain in temple area (may be excruciating)

  • Transient blurred vision

  • Loss of appetite

  • Fever

  • Fatigue

  • Depression 

  • Drooping lid

  • Double vision

  • Sore neck

  • Jaw soreness, especially when chewing food

 
Detection and Diagnosis

When temporal arteritis is suspected, the doctor will order  blood tests including a erythrocyte (red blood cell) sedimentation rate (ESR) and C-reactive protein test.  The ESR test measures the time it takes for the erythrocytes to collect in the bottom of a test tube.  The sediment layer of erythrocytes is measured in millimeters and recorded.   An abnormally high ESR is indicative of active inflammation.

C-reactive protein is produced in the liver.  This protein is released when the body responds to an injury or any other event that signals inflammation.  C-reactive protein is measured with a blood test.  

A biopsy of the temporal artery is usually recommended.  The procedure is performed with local anesthesia.  A small section of the temporal artery is removed and examined under magnification for inflammatory cells.  This test allows doctors to definitively diagnose temporal arteritis.
 
Treatment

The ophthalmologist often works in conjunction with the patient's internist to treat this disease.  The primary treatment for the disease is oral steroid medication to reduce the inflammatory process.  Most patients notice an improvement in their symptoms within several days.  In some cases, a long-term maintenance dosage of the steroid is required.   

 

Giant cell arteritis (GCA) is an inflammation of the lining of your arteries — the blood vessels that carry oxygen-rich blood from your heart to the rest of your body. Although GCA can affect the arteries in your neck, upper body and arms, it occurs most often in the arteries in your head and especially those in your temples. For that reason, the disorder is sometimes called temporal arteritis or cranial arteritis. GCA is also known as granulomatous arteritis — a reference to a particular type of inflammation.

GCA frequently causes headaches, jaw pain, and blurred or double vision, but the most serious potential complications are blindness and, less often, stroke. These problems can occur when swelling in the arteries impairs blood flow to your eyes or brain.

Older adults are at greatest risk of GCA. The disorder affects about 200 of every 100,000 people older than 50. The exact cause isn't known, but researchers believe that genetic, viral and environmental factors may play roles in the inflammation.

Although there's no cure for GCA, immediate treatment with corticosteroid medications usually relieves symptoms and prevents loss of vision.

 

The first case of GCA was described in 1890 by a British surgeon whose patient complained that severe head pain prevented him from wearing a hat. Times have changed, but the most common symptom of GCA is still head pain and tenderness — often severe — that usually occurs in both temples. Sometimes, however, you may have pain in only one temple or in the front of your head.

In addition to asking about your symptoms and past medical history, your doctor is likely to perform a thorough physical exam, paying particular attention to your temporal arteries. In about half of all people with GCA, one or both of these arteries are tender, with a reduced pulse and a hard, cord-like feel and appearance.

To help diagnose GCA, you also may have some of the following tests:

  • Blood tests. If your doctor suspects GCA, you're likely to have a blood test that checks your erythrocyte sedimentation rate - commonly referred to as the sed rate. This test measures how quickly red blood cells fall to the bottom of a tube of blood. Red cells that drop rapidly may indicate inflammation in your body. You also may have a test that measures C-reactive protein (CRP), a substance your liver produces when inflammation is present. The same tests may be used to follow your progress during treatment.
  • Cerebral angiogram. In some cases, you may need a more invasive X-ray test called a cerebral angiogram. During this procedure, a flexible tube (catheter) resembling a strand of spaghetti is inserted into a large artery — usually in your groin — and threaded past your heart into the cerebral arteries in your brain. A special dye (contrast medium) is then injected into the catheter and X-rays are taken as the dye fills these arteries. The test takes about an hour, and you'll need to rest in bed for a few hours afterward. A cerebral angiogram provides a clear picture of the arterial blood flow in your head, but the procedure isn't without risks, including bleeding at the catheter insertion site, infection and stroke.
  • Biopsy. Although blood tests and cerebral angiography can provide your doctor with useful information, the only way to confirm a diagnosis of GCA is by taking a small sample (biopsy) of the temporal artery. Because the inflammation may not occur in all parts of the artery, more than one sample may be needed. The procedure is performed on an outpatient basis under local anesthesia, usually with little discomfort or scarring. The sample is examined under a microscope in a laboratory. If you have GCA, the artery will often show inflammation that includes abnormally large cells, called giant cells, which give the disease its name.

    Unfortunately, a biopsy isn't foolproof. It's possible to have GCA and still have a negative biopsy result. If the results aren't clear, your doctor may advise a biopsy on the other side of your head.

 

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Son yenileme: 09/04/08