Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0039483 (giant cell arteritis)
 3,204 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One of the most susceptible sites to vascular diseases is the optic nerve head. By innovative approaches using morphometry and in situ hybridization, vascular and extracellular characteristics of the human optic nerve head were examined. Nonarteritic ischemic optic neuropathy occurs due to vascular insufficiency within the optic nerve head. Various local and systemic risk factors have been proposed among which smoking and acute hypotension are now included. Anatomically abnormal discs such as the small optic disc, tilted disc, and optic nerve drusen are recognized as "disks at risk" and hyperopia may be an additional predisposing factor. Ocular, neurological, and vascular disorders due to giant cell arteritis were reviewed. Intravenous high-dose methylprednine should be administered in certain cases. Differentiating nonarteritic from arteritic ischemic optic neuropathy is sometimes difficult. Isolated choroidal ischemia or choroidal filling delay may be an indication of giant cell arteritis. Studies have been conducted on the vascular event, amaurosis fugax (transient monocular visual loss), and the results of some of these studies are discussed.
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PMID:Neuro-ophthalmic aspects of vascular disease. 1015 Aug 24

Acute loss of vision due to anterior ischemic optic neuropathy, both arteritic and nonarteritic, demands investigation and where indicated, treatment as an emergency. While advances continue in the understanding of the pathophysiology and investigation of arteritic anterior ischemic optic neuropathy, the nonarteritic form presents a major therapeutic problem, particularly in the absence of a satisfactory clinical technique for the measurement of optic nerve head blood flow. Because of steroid resistance and side effects of chronic steroid therapy in giant cell arteritis, alternative immunosuppressive agents are being explored. In nonarteritic ischemic optic neuropathy, etiologic factors such as activated protein C resistance raise the possibility of evaluation for prothrombotic states, while calcium channel blockers offer prospects for the relief of ischemic effects at the cellular level.
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PMID:Ischemic optic neuropathy and giant cell arteritis. 1038 27

Although optic nerve enhancement may be seen in magnetic resonance imaging of radiation-induced ischemic optic neuropathy, similar enhancement in ischemic optic neuropathy has not been previously reported in the English-language neuroophthalmologic literature. We report three cases of optic nerve enhancement in biopsy-proven arteritic ischemic optic neuropathy. Clinicians should consider giant cell arteritis in the differential diagnosis of an optic neuropathy with optic nerve enhancement on magnetic resonance imaging.
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PMID:Optic nerve enhancement on magnetic resonance imaging in arteritic ischemic optic neuropathy. 1060 74

An ischemic stroke in an old patient is commonly due to thrombosis or embolism. A restriction in the differential diagnosis and not considering another etiology could occasion the loss of effective therapy and prevent major complications. We report the case of a patient who suffering from systemic symptoms for a few months, was admitted to the hospital with the one and a half syndrome described by Fisher, together with right facial palsy, both products of an ischemic pontine lesion. Bilateral biopsies of the temporal arteries were diagnostic of temporal arteritis and MRN of the cranium confirmed multiple ischemic lesions involving the pons. In conclusion, the diverse clinical presentations of temporal arteritis oblige us to consider it among the etiological options in older patients with neurological signs affecting the vertebral-basilar system, accompanied by systemic signs and symptoms and a high VSG. To avoid anterior ischemic optic neuropathy and other complications a quick diagnosis and treatment are necessary.
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PMID:[Fisher's one and half syndrome with facial palsy as clinical presentation of giant cell temporal arteritis]. 1096 18

Giant cell (temporal) arteritis (GCA) is the most common systemic vasculitis in Western countries. It involves large and medium-sized vessels with predisposition to the cranial arteries in the elderly. Cranial ischemic complications, in particular permanent visual loss, constitute the most feared aspects of this vasculitis. Although the use of corticosteroids and a higher physician awareness may have contributed to a decrease in the frequency of severe ischemic complications, permanent visual loss is still present in 7%-14% of patients. To investigate further the incidence, trends, and clinical spectrum of visual manifestations in patients with GCA, we examined the features of patients with biopsy-proven GCA diagnosed at the single reference hospital for a defined population in northwestern Spain during an 18-year period. Predictive factors for the development of any visual manifestation, not only permanent visual loss, were also examined. Between 1981 and 1998, 161 patients were diagnosed with biopsy-proven GCA. Visual ischemic complications were observed in 42 (26.1%), and irreversible blindness, mainly due to anterior ischemic optic neuropathy and frequently preceded by amaurosis fugax, was found in 24 (14.9%). Despite a progressive increase in the number of new cases diagnosed, there was not a significant change in the proportion of patients with visual manifestations during the study period (p = 0.37). Patients with visual ischemic complications had lower clinical and laboratory biologic markers of inflammation. Indeed, during the last years of the study, anemia was associated with a very low risk of visual complications. Also, HLA-DRB1*04-positive patients had visual manifestations more commonly. Patients with other ischemic complications developed irreversible blindness more frequently. The best predictors of any visual complication were HLA-DRB1*04 phenotype (odds ratio [OR] 7.47) and the absence of anemia at the time of admission (OR for patients with anemia = 0.07). The best predictors of irreversible blindness (permanent visual loss) were amaurosis fugax (OR 12.63) and cerebrovascular accidents (OR 26.51). The present study supports the claim that ocular ischemic complications are still frequent in biopsy-proven GCA patients from southern Europe. The presence of other ischemic complications constitutes an alarm for the development of irreversible blindness. In contrast, a higher inflammatory response may be a protective factor against the development of cranial ischemic events.
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PMID:Visual manifestations of giant cell arteritis. Trends and clinical spectrum in 161 patients. 1103 76

A 70-year-old man presented with a history of headache and sudden loss of vision of the left eye. Funduscopic examination showed sector retinal edema and hemorrhage as well as optic disc swelling consistent with anterior ischemic optic neuropathy. The Westergren sedimentation rate was 66 mm/h. Temporal artery biopsy was consistent with giant cell arteritis. Routine transcranial Doppler testing performed on a Pioneer 2020 instrument (Nicolet Vascular, Inc., Golden, CO) equipped with special software for microembolus detection showed a microembolic signal in the left ophthalmic artery. During a subsequent monitoring study, microembolic signals were detected in the anterior and middle cerebral arteries, bilaterally. Microembolism can occur in giant cell arteritis. Ophthalmic artery microembolism can be detected in vivo by transcranial Doppler ultrasonography. This new imaging capability can potentially be useful when evaluating patients with vascular disorders of the eye.
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PMID:Ophthalmic artery microembolism in giant cell arteritis. 1113 Jul 57

Ischaemic optic neuropathy is of two types: anterior (AION) and posterior (PION), the first involving the optic nerve head (ONH) and the second, the rest of the optic nerve. Pathogenetically AION and PION are very different diseases. AION represents an acute ischaemic disorder of the ONH supplied by the posterior ciliary artery (PCA), while PION has no specific location in the posterior part of the optic nerve and does not represent an ischaemic disorder of any definite artery. The most important step towards a logical understanding of the underlying causes, clinical features, pathogenesis and rational management of AION, is to understand the basic scientific issues involved; these are discussed in some detail. AION clinically is of two types: (1) that due to giant cell arteritis (arteritic AION: A-AION) and (2) non-arteritic AION (NA-AION). NA-AION, the more common of the two, is one of the most prevalent and visually crippling diseases in the middle-aged and elderly, and is potentially bilateral. NA-AION is a multifactorial disease, with many risk factors collectively contributing to its development. Although there is no known treatment for NA-AION, reduction of risk factors is important in decreasing chances of involvement of the second eye and of further episodes. Our studies have suggested that nocturnal arterial hypotension is an important risk factor for the development and progression of NA-AION. The role of nocturnal arterial hypotension in the pathogenesis of NA-AION and management of nocturnal hypotension is discussed. Potent antihypertensive drugs, when used aggressively and/or given at bedtime, are emerging as an important risk factor for nocturnal hypotension, and there is some evidence that NA-AION may be occurring as an iatrogenic disease in some individuals. A-AION, by contrast, is an ocular emergency and requires immediate treatment with systemic corticosteroids to prevent further visual loss. The clinical parameters which help to differentiate the two types of AION, and their respective management are discussed.
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PMID:Ischaemic optic neuropathy. 1121 49

This review presents highlights and updates from of the most significant clinical trials in neuro-ophthalmology to date, the Optic Neuritis Treatment Trial, the Controlled High-Risk Avonex Multiple Sclerosis Prevention Study, and the Ischemic Optic Neuropathy Decompression Trial. The quality of evidence for treatment efficacy from these trials and other recent investigations of giant cell arteritis and idiopathic intracranial hypertension is classified herein according to published criteria based on sample size and study design.
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PMID:Evidence-based neuro-ophthalmology: advances in treatment. 1173 77

Ischemic optic neuropathy (ION) is the most frequent optic neuropathy in patients older than 50. Anterior ION is classified as nonarteritic, especially in patients with vasculopathic risk factors and/or small optic disc, or arteritic. Monocular visual loss is usually sudden. Typical exam findings are optic nerve swelling and altitudinal visual field defect. Clinical profile, sedimentation rate, and especially fluorescein angiography are very useful to make the distinction between nonarteritic and arteritic ION. Treatment of temporal arteritis with steroids is an emergency but there is no effective therapy of the nonarteritic form.
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PMID:[Acute anterior, ischemic optic neuropathy]. 1182 34

We report a case of a 71-year-old man with sequential visual loss within 3 days due to giant cell arteritis confirmed by a temporal artery biopsy. The anterior ischemic optic neuropathy was associated with cilioretinal artery occlusion on the right eye. He improved after intravenous corticosteroid therapy. Clinical characteristics and treatment are discussed.
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PMID:[Acute ischemic optical neuropathy which became bilateral in 3 days in Horton disease]. 1189 39


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