temporal arteritis

Temporal Arteritis 

Definition

The term temporal arteritis literally means "inflammation of the temporal arteries." As implied by the name, these blood vessels run along the temples after they branch off from the carotid artery in the neck. They provide the blood supply to portions of the scalp, jaw muscles, and salivary glands. Inflammation of these arteries, probably resulting from an abnormal immune reaction, disrupts this blood supply, resulting in a variety of symptoms. They can range from relatively minor jaw pain or headache to major symptoms, including temporary or permanent blindness.

Temporal arteritis is also called giant cell arteritis or cranial arteritis. It is a rheumatic disease that affects large and medium-sized arteries throughout the body and can occur in a variety of patients. Although the temporal arteries are most commonly affected, other arteries throughout the body may be affected. The disease seems to target arteries containing elastic tissue. Veins are rarely affected. Temporal arteritis is a type of vasculitis.

Description

Temporal arteritis almost always occurs in people over 50, and it becomes more common as people age. About 20 out of 100,000 people over the age of 50 suffer from temporal arteritis. Women are affected twice as often as men. Some authorities say that temporal arteritis is more common in Caucasians (especially Scandinavians) than in people of other races. Close relatives of patients with temporal arteritis may be more likely than others to get the disease.

Patients with temporal arteritis are diagnosed and overlap with a broader disorder called giant cell arteritis. This can affect parts of the body in addition to the scalp, eyes, and jaw. Sometimes the disease can cause restricted circulation to both arms or both legs, producing pain in the affected limbs. With other blood vessels involved, patients with advanced forms of the disease may experience strokes or transient ischemic attacks (TIA). These result in brief episodes of pain caused by decreased blood flow. Even heart attacks are occasionally caused by giant cell arteritis.

Causes and symptoms

This disease is one of a group of diseases in which the linings of large- or medium-sized blood vessels become inflamed. The elastic layer of these vessels is attacked by "giant" cells and chemicals produced by the immune system. This reaction reduces blood flow through the blood vessels, and the limited blood supply causes the symptoms.

The disease usually begins with "flu-like" symptoms, including a mild fever (100-101°F), general body discomfort, and a persistent, dull headache. The scalp may be tender to the touch over the affected blood vessels. Jaw muscles sometimes become painful when the patient chews.

As the disease progresses, more severe symptoms occur. These include blurred vision or temporary blindness that typically lasts ten minutes or less. Eventually, permanent loss of vision can occur. Transient ischemic attacks, strokes, and heart attacks may occur when the disease is far advanced.

Diagnosis

Doctors from a number of specialties develop experience in diagnosing and treating temporal arteritis. These include internists, who treat a broad range of diseases; rheumatologists, who focus on rheumatic diseases; geriatricians, who treat older people; ophthalmologists, who treat eye and vision disorders; neurologists, who treat headaches and problems of the optic nerve; and vascular surgeons, who treat blood vessel problems.

The doctor will generally take a medical history first. The patient can help the doctor tremendously by reviewing all symptoms—both major and minor—from the last two or three months. If possible, the patient should ask family or close friends for help in recalling his/her ailments from recent months. Then the doctor will conduct a complete physical examination. Often, he or she will detect a tender, swollen artery on the scalp.

The doctor will order blood tests as well. A standard and inexpensive test called the erythrocyte sedimentation rate (ESR or "sed" rate) is particularly helpful. Results from this test, which measures inflammation in the body, will almost always be higher than normal. Tests of the red blood cells may show mild anemia. Sometimes blood tests for liver function will also be abnormal.

The definitive diagnostic test is a temporal artery biopsy. A doctor will make one or more tiny incisions under local anesthesia to remove samples of the suspect artery. Under the microscope, a pathologist usually can identify the typical damage caused by temporal arteritis.

Treatment

The mainstay of treatment is a course of corticosteroids (steroid hormones that have an anti-inflammatory effect), usually prednisone. The initial prescription involves a fairly high dose of steroids (40-60 mg/day) which is gradually tapered down to a maintenance dose. Because of the high incidence of blindness in untreated cases, steroid therapy should be started immediately rather than waiting for biopsy results. Patients typically take this maintenance dose for periods of one to three years. Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for muscle aches or headaches, especially while steroid doses are being reduced.

Prognosis

The outlook for most patients with temporal arteritis is good, especially if the disorder is diagnosed early. Symptoms often diminish within a month once patients begin to take steroids. Although physicians do not talk about a "cure" for temporal arteritis, symptoms typically do not return after a full course of steroid treatment. Unfortunately, if the diagnosis is made late in the disease, lost vision may not return.

Prevention

There is no medically proven approach to prevention. The best way to prevent severe, permanent damage is to obtain expert medical advice if the patient or the family physician suspects this problem.

Key terms

Anemia — Lower than normal level of red blood cells, or of the oxygen-carrying chemical hemoglobin.

Biopsy — Removal and examination of a sample tissue from the body for diagnostic purposes.

Corticosteroids — A group of hormones, produced naturally by the adrenal gland and other organs. They are used to treat a wide variety of disorders, including many rheumatic disorders.

Erythrocyte sedimentation rate — The speed at which red blood cells sink in a tube of freshly drawn blood, which is a rough measure of clotting disorders or inflammation.

Prednisone — A corticosteroid often used to treat inflammation.

Rheumatic disease — A type of disease involving inflammation of muscles, joints, and other tissues.

Transient ischemic attack — A brief experience of stroke-like symptoms (for instance, numbness, paralysis, problems in speaking or understanding speech) that go away within hours, with no permanent damage. Also known as TIA.

Vasculitis — An inflammation of the blood vessels.

Resources

Organizations

National Headache Foundation. 428 W. St. James Place, Chicago, IL 60614. (800) 843-2256. http://www.headaches.org.

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arteritis /ar·ter·i·tis/ (ahr″ter-i´tis) pl. arteri´tides   inflammation of an artery.

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aortic arch arteritis  Takayasu's a.

brachiocephalic arteritis , arteritis brachiocepha´lica Takayasu's a.

coronary arteritis  inflammation of the coronary arteries.

cranial arteritis  giant cell a.

giant cell arteritis  a chronic vascular disease of unknown origin, usually in the carotid arterial system, occurring in the elderly; it is characterized by severe headache, fever, and proliferative inflammation, often with giant cells and granulomas. Ocular involvement may cause blindness.

rheumatic arteritis  generalized inflammation of arterioles and arterial capillaries occurring in rheumatic fever.

Takayasu's arteritis  pulseless disease; progressive obliteration of the brachiocephalic trunk and left subclavian and left common carotid arteries, leading to loss of pulse in arms and carotids and to ischemia of brain, eyes, face, and arms.

temporal arteritis  giant cell a.

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temporal arteritis

n.

Arteritis that occurs in older persons and that is characterized by severe bitemporal headache, sudden loss of vision, and the presence of multinucleated giant cells in temporal, retinal, or intracerebral arteries. Also called cranial arteritis, giant cell arteritis.

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temporal arteritis

Etymology: L, temporalis, temporary, arteria, airpipe, itis, inflammation

a progressive inflammatory disorder of cranial blood vessels, principally the temporal artery. It occurs most frequently in women over 70 years of age. Characteristic changes in the involved vessels include granulomatous disruption of the elastic layer and engulfment of fiber fragments by giant cells in the intimal and medial layers. The temporal artery is typically tender, swollen, and pulseless but may be clinically normal. Symptoms are intractable headache, difficulty in chewing, weakness, rheumatic pains, and loss of vision if the central retinal artery becomes occluded. Also called cranial arteritis, giant cell arteritis, Horton's arteritis.

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temporal arteritis (tem·pôr·l är·t·rīˑ·ts),

n an inflammatory condition that most often occurs in older patients. Symptoms include jaw claudication, scalp sensitivity, thickening or slowing of the temporal artery, throbbing headache, and visual difficulty or discomfort and are accompanied by increased erythrocyte sedimentation rate.

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temporal arteritis (tem´prl är´-trī´tis),

n a progressive inflammatory disorder of cranial blood vessels, principally the temporal artery, occurring most commonly in women over 70 years of age. The temporal artery is typically tender, swollen, and pulseless. Symptoms are intractable headache, difficulty in chewing, weakness, rheumatoid pain, and loss of vision if the central retinal artery becomes occluded.

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arteritis, temporal 

An inflammatory disease of the wall of arteries, mainly of the extracranial vessels, which occurs in people who are over 60 years of age. The condition is characterized by headache and pain in muscles and joints, such as those of the jaws, tender or non-pulsating temporal artery, and sometimes fever. A sudden loss of vision in one eye (amaurosis fugax) may occur in the first few weeks after the onset of the disease due to an occlusion of either the central retinal artery or of the short posterior ciliary arteries that supply the optic nerve. Prompt administration of systemic corticosteroids (e.g. hydrocortisone) has been found to be of great value in the management of this condition. Syn. giant cell arteritis (strictly speaking this term is usually reserved for a more generalized condition). See amaurosis fugax; ischaemic optic neuropathy; Adie's pupil.

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temporal arteritis

Cranial arteritis, giant cell arteritis, granulomatous arteritis Neurology A self-limited disease of middle-aged ♀ characterized by vasculitis of the carotid artery which evolves to systemic arteritis in 10-15% of Pts; blindness, strokes possible as late complications Diagnosis Temporal artery biopsy Management High-dose prednisone, tapered to low-dose

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Patient discussion about temporal arteritis.

Q. What are side effects after you have had a temporal arteritis biopsy?

A. like every biopsy- when there are anatomical variations you might cause damage. but that is fairly rare...from what i remember it's a very safe procedure.