Synonyms:
a.k.a. cranial arteritis a.k.a. temporal arteritis:
Diagnosis:
Biopsy of the temporal artery within 7 days of starting steroids:
- With serial sectioning
Or clinical features plus raised ESR or CRP plus response to steroids
Pathology:
Panarteritis:
- Intimal thickening and proliferation,
- Lymphocytic infiltration of media and adventitia, giant cells,
- Disruption of elastic lamina
Chronic phase: intimal thickening, fibrosis, fragmentation of elastic lamina
Clinical features:
Fever, anemia, elderly
Orbital pain, vision loss
Altitudinal visual field defect (superior or inferior), diplopia
Optic disc: Pale, swollen. Central retinal artery occlusion
III, IV, VI palsy
Tender temporal artery
Findings on Investgations:
+ESR >80 or CRP >1 or 10
Catheter angiography:
- May show abnormalities in extracranial vessels
Treatment:
Do not wait for biopsy to start treatment
Glucocorticoid therapy Prednisone I.V. high dose 60 mg then oral
Monitor with ESR and symptoms. Titrate the steroid dose
Continue therapy for at least 1-2 years