Giant cell arteritis temporal or cranial arteritis
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GIANT CELL ARTERITIS (Temporal or Cranial Arteritis). Idiopathic vasculitis Same disease spectrum as polymyalgia rheumatica Mainly women 65-80 years old Medium and large arteries in head & neck involved. Headache Scalp tenderness Thickened temporal arteries Jaw claudication

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GIANT CELL ARTERITIS(Temporal or Cranial Arteritis)

  • Idiopathic vasculitis

  • Same disease spectrum as polymyalgia rheumatica

  • Mainly women 65-80 years old

  • Medium and large arteries in head & neck involved


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Headache

Scalp tenderness

Thickened temporal arteries

Jaw claudication

Acute visual loss

Weight loss, anorexia, fever, night sweats, malaise & depression

GIANT CELL ARTERITISPresentation


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GIANT CELL ARTERITISOcular Complications

  • Transient monocular visual loss (amaurosis fugax)

  • Visual loss due to

    • Central retinal artery occlusion (CRAO) or

    • Anterior ischaemic optic neuropathy (AION)

  • Visual field defects


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GIANT CELL ARTERITISManagement

  • ESR if suspected

  • Start high dose steroids immediately to prevent stroke or second eye involvement

  • Temporal artery biopsy within a week of starting steroids


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GIANT CELL ARTERITIS Temporal Artery Biopsy

  • Arteries have skip lesions

  • ultrasound/Doppler may help identify involved areas

  • If positive, confirms diagnosis – helpful in management of future disease

  • If negative, doesn’t exclude diagnosis, but need to think about an alternative diagnosis


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GIANT CELL ARTERITISHistopathology

  • Granulomatous cell infiltration

  • Giant cells

  • Disruption of internal elastic lamina

  • Proliferation of intima

  • Occlusion of lumen


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GIANT CELL ARTERITISTreatment

  • Intravenous and oral steroids – prolonged course of steroids often necessary


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