Temporal arteritis physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with temporal arteritis usually appear in pain or normal. The presence of temporal tenderness on physical examination is highly suggestive of temporal arteritis. Ophthalmoscopic exam may be abnormal with findings of sludging of blood in retinal arterioles, optic disc may show chalky white pallor and edema, with or without splinter hemorrhages, posterior ischemic (retrobulbar) optic neuropathy, central retinal artery occlusion, branch of retinal artery occlusion, and choroidal ischemia. Tenderness upon palpation of the temporal region including erythema, nodularity, and thickening on affected side. Other findings include facial tenderness, diplopia, ptosis, nystagmus, internuclear ophthalmoplegia (INO), and pupillary abnormalities. | Patients with temporal arteritis usually appear in [[pain]] or normal. The presence of temporal tenderness on physical examination is highly suggestive of temporal arteritis. [[Ophthalmoscope|Ophthalmoscopic exam]] may be abnormal with findings of sludging of blood in [[Retinal artery|retinal arterioles]], [[optic disc]] may show chalky white [[pallor]] and [[edema]], with or without [[Splinter hemorrhage|splinter hemorrhages]], [[Posterior ischemic optic neuropathy|posterior ischemic (retrobulbar) optic neuropathy]], [[Central retinal artery|central retinal artery occlusion]], branch of [[Central retinal artery|retinal artery]] occlusion, and [[Choroid|choroidal]] [[ischemia]]. [[Tenderness]] upon palpation of the temporal region including [[erythema]], nodularity, and thickening on affected side. Other findings include facial [[tenderness]], [[diplopia]], [[ptosis]], [[nystagmus]], [[Internuclear ophthalmoplegia|internuclear ophthalmoplegia (INO)]], and [[Pupil|pupillary]] abnormalities. | ||
==Physical Examination== | ==Physical Examination== | ||
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===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with temporal arteritis usually appear in pain. | *Patients with temporal arteritis usually appear in [[pain]]. | ||
===Vital Signs=== | ===Vital Signs=== | ||
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===HEENT=== | ===HEENT=== | ||
*Ophthalmoscopic exam may be abnormal with findings of sludging of blood in retinal arterioles, optic disc may show chalky white pallor and edema, with or without splinter hemorrhages, posterior ischemic (retrobulbar) optic neuropathy, central retinal artery occlusion, branch of retinal artery occlusion, and choroidal ischemia | *[[Ophthalmoscope|Ophthalmoscopic]] exam may be abnormal with findings of sludging of [[blood]] in [[retinal]] [[Arteriole|arterioles]], [[optic disc]] may show chalky white [[pallor]] and [[edema]], with or without [[Splinter hemorrhage|splinter hemorrhages]], [[Posterior ischemic optic neuropathy|posterior ischemic (retrobulbar) optic]] neuropathy, [[central retinal artery]] [[occlusion]], branch of [[Central retinal artery|retinal artery]] [[occlusion]], and [[Choroid|choroidal]] [[ischemia]]<ref name="SahaRehman2005">{{cite journal|last1=Saha|first1=N|last2=Rehman|first2=S U|title=Reversal of chronic ocular ischaemia with good visual recovery in giant cell arteritis|journal=Eye|volume=20|issue=6|year=2005|pages=742–743|issn=0950-222X|doi=10.1038/sj.eye.6701998}}</ref><ref name="pmid11130757">{{cite journal| author=Schäuble B, Wijman CA, Koleini B, Babikian VL| title=Ophthalmic artery microembolism in giant cell arteritis. | journal=J Neuroophthalmol | year= 2000 | volume= 20 | issue= 4 | pages= 273-5 | pmid=11130757 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11130757 }} </ref><ref name="pmid16033712">{{cite journal| author=Schmidt D| title=Ocular ichemia syndrome - a malignant course of giant cell arteritis. | journal=Eur J Med Res | year= 2005 | volume= 10 | issue= 6 | pages= 233-42 | pmid=16033712 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16033712 }} </ref><ref name="pmid10387340">{{cite journal| author=Tovilla-Canales JL| title=Ocular manifestations of giant cell arteritis. | journal=Curr Opin Ophthalmol | year= 1998 | volume= 9 | issue= 6 | pages= 73-9 | pmid=10387340 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10387340 }} </ref><ref name="pmid12972779">{{cite journal| author=Al-Abdulla NA, Kelley JS, Green WR, Miller NR| title=Herpes zoster vasculitis presenting as giant cell arteritis with choroidal infarction. | journal=Retina | year= 2003 | volume= 23 | issue= 4 | pages= 567-9 | pmid=12972779 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12972779 }} </ref><ref name="pmid11177002">{{cite journal| author=Casson RJ, Fleming FK, Shaikh A, James B| title=Bilateral ocular ischemic syndrome secondary to giant cell arteritis. | journal=Arch Ophthalmol | year= 2001 | volume= 119 | issue= 2 | pages= 306-7 | pmid=11177002 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11177002 }} </ref> | ||
* Tenderness upon palpation of the temporal region including erythema, nodularity, and thickening on affected side | *[[Tenderness]] upon [[palpation]] of the [[temporal]] region including [[erythema]], nodularity, and thickening on affected side | ||
* Facial tenderness | *[[Facial]] [[tenderness]] | ||
*Neuro-ophthalmic manifestations | *Neuro-[[Ophthalmic artery|ophthalmic]] manifestations of temporal arteritis include the following:<ref name="pmid18606086">{{cite journal| author=Borg FA, Salter VL, Dasgupta B| title=Neuro-ophthalmic complications in giant cell arteritis. | journal=Curr Allergy Asthma Rep | year= 2008 | volume= 8 | issue= 4 | pages= 323-30 | pmid=18606086 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18606086 }} </ref> | ||
**Diplopia | **[[Diplopia]] | ||
**Ptosis | **[[Ptosis]]<ref name="pmid11203169">{{cite journal| author=Killer HE, Holtz DJ, Kaiser HJ, Laeng RH| title=Diplopia, ptosis, and hepatitis as presenting signs and symptoms of giant cell arteritis. | journal=Br J Ophthalmol | year= 2000 | volume= 84 | issue= 11 | pages= 1319-20 | pmid=11203169 | doi= | pmc=1723314 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11203169 }} </ref> | ||
**Nystagmus | **[[Nystagmus]] | ||
**Internuclear ophthalmoplegia (INO) | **[[Internuclear ophthalmoplegia|Internuclear ophthalmoplegia (INO)]]<ref name="pmid10366177">{{cite journal| author=Ahmad I, Zaman M| title=Bilateral internuclear ophthalmoplegia: an initial presenting sign of giant cell arteritis. | journal=J Am Geriatr Soc | year= 1999 | volume= 47 | issue= 6 | pages= 734-6 | pmid=10366177 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10366177 }} </ref> | ||
**Pupillary abnormalities | **[[Pupil|Pupillary]] abnormalities<ref name="pmid12642330">{{cite journal| author=Foroozan R, Buono LM, Savino PJ, Sergott RC| title=Tonic pupils from giant cell arteritis. | journal=Br J Ophthalmol | year= 2003 | volume= 87 | issue= 4 | pages= 510-2 | pmid=12642330 | doi= | pmc=1771609 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12642330 }} </ref> | ||
===Neck=== | ===Neck=== | ||
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[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
Patients with temporal arteritis usually appear in pain or normal. The presence of temporal tenderness on physical examination is highly suggestive of temporal arteritis. Ophthalmoscopic exam may be abnormal with findings of sludging of blood in retinal arterioles, optic disc may show chalky white pallor and edema, with or without splinter hemorrhages, posterior ischemic (retrobulbar) optic neuropathy, central retinal artery occlusion, branch of retinal artery occlusion, and choroidal ischemia. Tenderness upon palpation of the temporal region including erythema, nodularity, and thickening on affected side. Other findings include facial tenderness, diplopia, ptosis, nystagmus, internuclear ophthalmoplegia (INO), and pupillary abnormalities.
Physical Examination
- The presence of temporal tenderness on physical examination is highly suggestive of temporal arteritis.
Appearance of the Patient
- Patients with temporal arteritis usually appear in pain.
Vital Signs
- Vital signs are with in normal limits.
Skin
- Skin examination of patients with temporal is usually normal.
HEENT
- Ophthalmoscopic exam may be abnormal with findings of sludging of blood in retinal arterioles, optic disc may show chalky white pallor and edema, with or without splinter hemorrhages, posterior ischemic (retrobulbar) optic neuropathy, central retinal artery occlusion, branch of retinal artery occlusion, and choroidal ischemia[1][2][3][4][5][6]
- Tenderness upon palpation of the temporal region including erythema, nodularity, and thickening on affected side
- Facial tenderness
- Neuro-ophthalmic manifestations of temporal arteritis include the following:[7]
Neck
- Neck examination of patients with temporal arteritis is usually normal.
Lungs
- Pulmonary examination of patients with temporal arteritis is usually normal.
Heart
- Cardiovascular examination of patients with temporal arteritis is usually normal.
Abdomen
Abdominal examination of patients with temporal arteritis is usually normal.
Back
- Back examination of patients with temporal arteritis is usually normal.
Genitourinary
- Genitourinary examination of patients with temporal arteritis is usually normal.
Neuromuscular
- Neuromuscular examination of patients with temporal arteritis is usually normal.
Extremities
- Extremities examination of patients with temporal arteritis is usually normal.
References
- ↑ Saha, N; Rehman, S U (2005). "Reversal of chronic ocular ischaemia with good visual recovery in giant cell arteritis". Eye. 20 (6): 742–743. doi:10.1038/sj.eye.6701998. ISSN 0950-222X.
- ↑ Schäuble B, Wijman CA, Koleini B, Babikian VL (2000). "Ophthalmic artery microembolism in giant cell arteritis". J Neuroophthalmol. 20 (4): 273–5. PMID 11130757.
- ↑ Schmidt D (2005). "Ocular ichemia syndrome - a malignant course of giant cell arteritis". Eur J Med Res. 10 (6): 233–42. PMID 16033712.
- ↑ Tovilla-Canales JL (1998). "Ocular manifestations of giant cell arteritis". Curr Opin Ophthalmol. 9 (6): 73–9. PMID 10387340.
- ↑ Al-Abdulla NA, Kelley JS, Green WR, Miller NR (2003). "Herpes zoster vasculitis presenting as giant cell arteritis with choroidal infarction". Retina. 23 (4): 567–9. PMID 12972779.
- ↑ Casson RJ, Fleming FK, Shaikh A, James B (2001). "Bilateral ocular ischemic syndrome secondary to giant cell arteritis". Arch Ophthalmol. 119 (2): 306–7. PMID 11177002.
- ↑ Borg FA, Salter VL, Dasgupta B (2008). "Neuro-ophthalmic complications in giant cell arteritis". Curr Allergy Asthma Rep. 8 (4): 323–30. PMID 18606086.
- ↑ Killer HE, Holtz DJ, Kaiser HJ, Laeng RH (2000). "Diplopia, ptosis, and hepatitis as presenting signs and symptoms of giant cell arteritis". Br J Ophthalmol. 84 (11): 1319–20. PMC 1723314. PMID 11203169.
- ↑ Ahmad I, Zaman M (1999). "Bilateral internuclear ophthalmoplegia: an initial presenting sign of giant cell arteritis". J Am Geriatr Soc. 47 (6): 734–6. PMID 10366177.
- ↑ Foroozan R, Buono LM, Savino PJ, Sergott RC (2003). "Tonic pupils from giant cell arteritis". Br J Ophthalmol. 87 (4): 510–2. PMC 1771609. PMID 12642330.