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{{Infobox_Disease |
__NOTOC__
  Name          = Temporal arteritis |
  Image          = Gray508.png |
  Caption        = The arteries of the face and scalp. |
  DiseasesDB    = 12938 |
  ICD10          = {{ICD10|M|31|5|m|30}} |
  ICD9          = {{ICD9|446.5}} |
  ICDO          = |
  OMIM          = 187360 |
  MedlinePlus    = |
  MeshID        = D013700 |
}}
{{Temporal arteritis}}
{{Temporal arteritis}}


{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}
'''For patient information, click [[Temporal arteritis (patient information)|here]]'''


{{SK}} GCA; giant cell arteritis; cranial arteritis; Horton's disease; Horton disease; Horton's arteritis; Horton syndrome; Horton's syndrome; granulomatous arteritis; polymyalgia arteritica;  
{{CMG}}; {{AE}} {{HQ}}


==Overview==
{{SK}} GCA; giant cell arteritis; cranial arteritis; Horton's disease; Horton disease; Horton's arteritis; Horton syndrome; Horton's syndrome; Horton-Magath-Brown syndrome granulomatous arteritis; polymyalgia arteritica
'''Temporal arteritis''' is an [[inflammation|inflammatory]] disease of [[blood vessel]]s (most commonly large and medium [[artery|arteries]] of the head). It is therefore a form of [[vasculitis]]. The name comes from the most frequently involved vessel ([[temporal artery]] which branches from the [[external carotid artery]] of the neck). The alternative name (giant cell arteritis) reflects the type of inflammatory cell that is involved (as seen on [[biopsy]]).


This diagnosis should be considered in any patient over the age of 50 with the new onset of [[headache]], particularly is the [[erythrocyte sedimentation rate]] is elevated.
==[[Temporal arteritis overview|Overview]]==


Prompt treatment with steroids is a medical emergency to reduce the risk of [[blindness]].
==[[Temporal arteritis historical perspective|Historical Perspective]]==


==History==
==[[Temporal arteritis classification|Classification]]==


==Epidemiology and Demographics==
==[[Temporal arteritis pathophysiology|Pathophysiology]]==


==[[Temporal arteritis causes|Causes]]==


==Pathophysiology==
==[[Temporal arteritis differential diagnosis|Differentiating Temporal Arteritis from other Diseases]]==


The damage to the vasuclature is mediated by an attack on the internal elastica lamina by activated CD4+ [[T helper cell]]s.  This occurs in repsonse to the presentation of an [[antigen]] by [[macrophages]]. The inciting antigen has not been identified.
==[[Temporal arteritis epidemiology and demographics|Epidemiology and Demographics]]==


Because the disease involves only arteries with internal elastic lamina, the aortic arch and its branches are often involved. Intracranial arteries do not have internal elastic lamina and are not involved. The distribution of involved arteries are as follows:
==[[Temporal arteritis risk factors|Risk Factors]]==


==='''''Commonly involved sites:'''''===
==[[Temporal arteritis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
'''Cervicocephalic arteries''': [[carotid artery]] and [[vertebral artery]].  The [[vertebral artery]] is involved as frequently as the temporal artery in fatal cases. Involvement of the [[basilar artery]] is rare.
 
'''Intraorbital branches''': Posterior ciliary artery and [[ophthalmic artery]].
 
'''External common, external, and internal carotid artery involvement:''' It is less common for proximal intracranial arteries to be involved.
 
'''External vertebral arteritis:''' It is less common though for the disease to extend more than 5 mm beyond the dural penetration.
 
'''Subclavian, axially and proximal brachial artery:''' There can be typical vasculitic lesions with long, smooth, lesions with tapered occlusions.
 
'''Coronary arteries''': for a full discussion of the involvement of the heart in this disorder see the chapter on [[The Heart in Temporal Arteritis / Giant Cell Arteritis]]
 
==='''''Less commonly involved sites:'''''===
 
'''Descending aorta:''' Mesenteric, iliac, femoral and renal arteries are less often involved. In these cases there can be [[mesenteric ischemia]], [[renal infarction]], and ischemic [[mononeuropathy]] can occur.
 
'''Pulmonary artery'''


==Diagnosis==
==Diagnosis==
 
[[Temporal arteritis diagnostic study of choice|Diagnostic Study of Choice]] | [[Temporal arteritis history and symptoms|History and Symptoms]] | [[Temporal arteritis physical examination|Physical Examination]] | [[Temporal arteritis laboratory findings|Laboratory Findings]] | [[Temporal arteritis CT|CT]] | [[Temporal arteritis MRI|MRI]] | [[Temporal arteritis echocardiography or ultrasound|Ultrasound]] | [[Temporal arteritis other imaging findings|Other Imaging Findings]] | [[Temporal arteritis other diagnostic studies|Other Diagnostic Studies]]
===Symptoms===
 
==Diagnosis==
 
===Biopsy===
The [[Gold standard (test)|gold standard]] for diagnosing temporal arteritis is [[biopsy]], which involves removing of a small part of the vessel and examining it [[microscope|microscopically]] for giant cells infiltrating the tissue. Since the [[blood vessel]]s are involved in a patchy pattern, there may be unaffected areas on the vessel and the biopsy might have been taken from these parts. So, a [[false negative|negative result]] does not definitely rule out the diagnosis.
 
===Radiology===
Radiological examination of the temporal artery with [[ultrasound]] yields a [[halo sign]].
Contrast enhanced brain MRI and CT is generally negative in this disorder.


==Treatment==
==Treatment==
[[Corticosteroid]]s must be started as soon as the diagnosis is suspected (even before the diagnosis is confirmed by biopsy). Steroids do not prevent the diagnosis later being confirmed by biopsy, although certain changes in the histology may be observed towards the end of the first week of treatment and are more difficult to identify after a couple of months.<ref name="pmid16987903">{{cite journal |author=Font RL, Prabhakaran VC |title=Histological parameters helpful in recognising steroid-treated temporal arteritis: an analysis of 35 cases |journal=The British journal of ophthalmology |volume=91 |issue=2 |pages=204–9 |year=2007 |pmid=16987903 |doi=10.1136/bjo.2006.101725}}</ref>
[[Temporal arteritis medical therapy|Medical Therapy]] | [[Temporal arteritis surgery|Surgery]] | [[Temporal arteritis primary prevention|Primary Prevention]] | [[Temporal arteritis secondary prevention|Secondary Prevention]] | [[Temporal arteritis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Temporal arteritis future or investigational therapies|Future or Investigational Therapies]]
 
A 3 day course of pulse steroids with 250 mg of IV [[solumedrol]] BID is critical in reducing the risk of permanent [[visual loss]]. If there is progression of visual loss on steroids, IV [[heparin]] can be administered to reduce the risk of thrombotic occlusion.
 
Treatment should not be deferred while waiting on the results of a [[temporal artery]] biopsy.
 
==References==
{{reflist|2}}


==Additional Resources==
==Case Studies==
*[http://www.niams.nih.gov/hi/topics/polymyalgia/ Polymyalgia Rheumatica]
[[Temporal arteritis case study one|Case #1]]


{{Diseases of the musculoskeletal system and connective tissue}}
{{Diseases of the musculoskeletal system and connective tissue}}
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[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Disease]]




Latest revision as of 19:07, 16 April 2018

Temporal Arteritis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Temporal Arteritis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Temporal arteritis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Temporal arteritis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Temporal arteritis

CDC on Temporal arteritis

Temporal arteritis in the news

Blogs on Temporal arteritis

Directions to Hospitals Treating Temporal arteritis

Risk calculators and risk factors for Temporal arteritis

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Synonyms and keywords: GCA; giant cell arteritis; cranial arteritis; Horton's disease; Horton disease; Horton's arteritis; Horton syndrome; Horton's syndrome; Horton-Magath-Brown syndrome granulomatous arteritis; polymyalgia arteritica

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Temporal Arteritis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice | History and Symptoms | Physical Examination | Laboratory Findings | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Template:Diseases of the musculoskeletal system and connective tissue


de:Arteriitis cranialis


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