Difference between revisions of "Giant cell arteritis"
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Clinical features: | Clinical features: | ||
*Classic finding: jaw claudication, in a patient older than 50 years. | *Classic finding: jaw claudication, in a patient older than 50 years. | ||
*Other findings: headache, vision loss or diplopia, scalp tenderness, polymyalgia, weight loss, chills, fever. | *Other findings: headache (very common),<ref name=pmid25457237>{{Cite journal | last1 = Le | first1 = K. | last2 = Bools | first2 = LM. | last3 = Lynn | first3 = AB. | last4 = Clancy | first4 = TV. | last5 = Hooks | first5 = WB. | last6 = Hope | first6 = WW. | title = The effect of temporal artery biopsy on the treatment of temporal arteritis. | journal = Am J Surg | volume = | issue = | pages = | month = Oct | year = 2014 | doi = 10.1016/j.amjsurg.2014.07.007 | PMID = 25457237 }}</ref> vision loss or diplopia, scalp tenderness, polymyalgia, weight loss, chills, fever. | ||
Work-up: | Work-up: | ||
| Line 46: | Line 46: | ||
Treatment: | Treatment: | ||
*Treat right away with high dose steroids. | *Treat right away with high dose steroids. | ||
**Biopsy is confirmatory. | **Biopsy is confirmatory. | ||
==Microscopic== | ==Microscopic== | ||
Revision as of 08:06, 17 December 2014
| Giant cell arteritis | |
|---|---|
| Diagnosis in short | |
 Giant cell arteritis. H&E stain. | |
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| |
| Synonyms | temporal arteritis |
|
| |
| LM | large artery with intramural inflammatory cells (often granulomatous); destruction of arterial wall, i.e. fibrinoid necrosis (pink anucleate arterial wall) |
| Site | large blood vessels - see vasculitides |
|
| |
| Clinical history | patient older than 50 years |
| Signs | loss of vision, weight loss, chills, fever |
| Symptoms | jaw claudication (classic), headache (classic), double vision, scalp tenderness |
| Prevalence | uncommon |
| Blood work | ESR elevated |
| Prognosis | good if treated |
| Clin. DDx | other causes of headache |
| Treatment | steroids |
Giant cell arteritis (abbreviated GCA), also known as temporal arteritis, is a type of large vessel vasculitis.
General
- Classically afflicts the temporal artery.
Clinical features:
- Classic finding: jaw claudication, in a patient older than 50 years.
- Other findings: headache (very common),[1] vision loss or diplopia, scalp tenderness, polymyalgia, weight loss, chills, fever.
Work-up:
- CRP, ESR, temporal artery biopsy.
- ESR normal (>50 years old): <20 mm/hr males, <30 mm/hr females.[2]
Treatment:
- Treat right away with high dose steroids.
- Biopsy is confirmatory.
Microscopic
Features:
- Artery with intramural inflammatory cells.
- Classically granulomatous inflammation.
- Granulomas not required for the diagnosis!
- Classically granulomatous inflammation.
- Destruction of arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).
Images
GCA - very low mag. (WC)
GCA - low mag. (WC)
GCA - intermed. mag. (WC)
GCA - high mag. (WC)
GCA - intermed mag. (WC)
GCA - high mag. (WC)
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Negative
TEMPORAL ARTERY, LEFT, BIOPSY: - MEDIUM SIZE ARTERY WITHOUT PATHOLOGIC DIAGNOSIS, SEE COMMENT. COMMENT: A negative biopsy does not rule out the possibility of giant cell (temporal) arteritis, as this may be a focal disorder. The clinical management is dependent upon the clinical impression.
See also
References
- ↑ Le, K.; Bools, LM.; Lynn, AB.; Clancy, TV.; Hooks, WB.; Hope, WW. (Oct 2014). "The effect of temporal artery biopsy on the treatment of temporal arteritis.". Am J Surg. doi:10.1016/j.amjsurg.2014.07.007. PMID 25457237.
- ↑ URL: http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm. Accessed on: 17 August 2012.