Temporal arteritis physical examination: Difference between revisions
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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<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> | *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<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>[82, 83] | ||
* 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 | ||
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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][82, 83]
- Tenderness upon palpation of the temporal region including erythema, nodularity, and thickening on affected side
- Facial tenderness
- Neuro-ophthalmic manifestations [85] of temporal arteritis include the following:
- Diplopia
- Ptosis [86]
- Nystagmus
- Internuclear ophthalmoplegia (INO) [87]
- Pupillary abnormalities [88]
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.