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Query: UMLS:C0039483 (giant cell arteritis)
 3,204 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pain around the eye can be caused by local ophthalmic disorders or by disease of other structures sharing trigeminal nerve sensory innervation. In general, most ocular causes for pain also cause the eye to be red, thus alerting the examiner to the focality of the problem. However, conditions like eyestrain, intermittent angleclosure glaucoma or neovascular glaucoma, and low-grade intraocular inflammation can be painful and not be associated with obvious redness. Ocular signs and symptoms also occur with numerous other causes of headache. Double vision in association with periocular pain can result from orbital lesions, isolated cranial neuropathies, and cavernous sinus lesions. Pupillary abnormalities like Horner's syndrome may result from a variety of painful conditions, including cluster headache, parasellar neoplasms or aneurysms, internal carotid dissection or occlusion, and Tolosa-Hunt syndrome. Pain with a dilated and unreactive pupil may reflect a benign condition like Adie's syndrome or ophthalmoplegic migraine, or it may herald the presence of a life-threatening posterior communicating artery aneurysm. Headache and transient visual loss can be manifestations of classic migraine, or be symptoms of ocular hypoperfusion from ipsilateral internal carotid occlusion or increased intracranial pressure from pseudotumor cerebri. In a young patient, head pain with a fixed visual deficit may result from optic neuritis, in an older adult, temporal arteritis may be the culprit. Ophthalmologic aspects of headache thus encompass problems that range from simple and benign to complex and formidable.
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PMID:Ophthalmologic aspects of headache. 202 Feb 23

The head and face contain one of the densest and richest nerve supplies in the body. Consequently, the face and head are particularly sensitive to pain, and patients afflicted with pain involving these parts of their bodies often come to feel that they are being subjected to the most unbearable tortures. Fortunately, specific and effective pharmacotherapy is now available for many of these conditions. This article reviews the indications, dosing regimens, and potential side effects of the drugs used for the treatment of trigeminal and glossopharyngeal neuralgia, posttherapeutic neuralgia, temporal arteritis, and migraine based on the clinical pharmacology of these drugs, so that the most appropriate treatment for each patient can be chosen on a sound, rational basis.
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PMID:Clinical pharmacology of drugs used to treat head and face pain. 218 Dec 62

A variety of rheumatologic disorders affect the elderly. Some of these problems are seen almost exclusively in the elderly, such as temporal arteritis and pseudogout. Because of underlying chronic diseases, these patients are also at increased risk for joint infection and resultant sepsis. Evaluation of synovial fluid from the inflamed joint is important. Light microscopy evaluation with a red polarizing compensator can help diagnose crystal-mediated disease, such as gout or pseudogout. Examination of Gram stains can help diagnose infectious arthritis. Thus, appropriate processing of synovial fluid is mandatory for the diagnosis of many rheumatologic disorders that occur in the elderly. A variety of metabolic disorders are associated with pseudogout and should be searched for on laboratory evaluation. Appropriate laboratory evaluation and follow-up following the acute episode are important in the care of these patients. For example, temporal arteritis with resultant blindness is a feared disorder in the elderly. Transient blindness, headaches, jaw claudication, and an elevated Westergren sedimentation rate suggest this diagnosis. Aches and pain in the neck and shoulder area, especially in the morning, are typical of polymyalgia rheumatica. Polymyalgia rheumatica may also be a symptom of temporal arteritis.
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PMID:Acute rheumatologic disorders in the elderly. 218 87

Polymyalgia rheumatica is a syndrome that occurs in the elderly and is characterized by pain and stiffness involving the neck, the shoulder girdle, and the hip girdle. The aching should be present for greater than one month. Polymyalgia rheumatica may be more common than reported. The etiology remains unknown. There is generally little found pathologically in this disease. The physical examination is often not impressive. Synovitis may be a main contributing factor to many of the symptoms seen in patients with polymyalgia rheumatica. Symptoms often do not correlate with physical findings. Polymyalgia rheumatica must be differentiated from many conditions since the diagnosis remains entirely clinical. Osteoarthritis, flu syndromes, inflammatory myopathies, fibromyalgia, and depression all have features that may mimic polymyalgia rheumatica. Malignancies and infections may also be difficult to separate from polymyalgia rheumatica. Polymyalgia rheumatica may also be extremely difficult to differentiate from seronegative rheumatoid arthritis in patients older than 50 years. Although some patients with polymyalgia rheumatica have underlying giant cell arteritis, the majority apparently do not. The distinction between polymyalgia rheumatica and giant cell arteritis cannot be made on the basis of laboratory studies and relies solely on clinical symptoms and physical findings. Although nonsteroidal antiinflammatory medications may control symptoms in patients with mild disease, most patients with polymyalgia rheumatica require low-dose corticosteroids. The tapering schedule for the corticosteroids is contingent upon the response of symptoms and laboratory parameters. Polymyalgia rheumatica usually follows a benign course with almost complete response to an adequate treatment program. Recently, there have been several studies suggesting that the course of polymyalgia rheumatica may not be as short and simple as once proposed. Nevertheless, many patients may be completely weaned from corticosteroids. Other agents have been used in this disease, but for the most part their use remains somewhat controversial. Patients must be monitored carefully. Most patients do well, and treatment is effective.
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PMID:Polymyalgia rheumatica. 218 54

All patients who present with severe headaches merit careful medical and neurologic evaluation, and many require neuroimaging studies or lumbar puncture. To avoid missing the occasional seriously ill patient among the large number of patients with relatively benign headaches, physicians must maintain a high index of suspicion and a familiarity with the differential diagnosis. Patients with severe acute headaches must be evaluated for subarachnoid hemorrhage and bacterial meningitis. Temporal arteritis must be excluded in all older patients with recurrent headaches of recent onset. Trigeminal neuralgia and cluster headache usually do not signify serious underlying disease, but the severity of the pain mandates rapid diagnosis and institution of therapy. Migraines are extremely common and often mislabeled as tension or sinus headaches. All primary care physicians should be able to recognize the many faces of migraine and be familiar with symptomatic and prophylactic therapy. Difficult cases should be referred to a neurologist for ongoing care.
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PMID:Severe headaches. When to worry, what to do. 231 44

The authors recently observed 2 elderly female patients with ischemic pain of the upper extremity as the first manifestation of giant cell arteritis. They presented with rest pain of both upper extremities and even gangrene of the thumb in 1 case. Subclavian and radial pulses were absent while peripheral pulses in the lower limbs were preserved. The angiography was so typical that the diagnosis of inflammatory arteritis was made, despite negative temporal artery biopsy. The patient with thumb gangrene was successfully operated on, the occlusive axillary lesions being bypassed by a long venous carotid humeral bypass graft. A biopsy of the axillary artery showed a granulomatous lymphoplasmocellular infiltration. A high-dose corticotherapy (24 mg daily) was begun in both cases, with dramatic improvements of general state, lowering of the erythrocyte sedimentation rate, and even reapparition of a reduced radial pulse in 1 patient. The authors discuss the incidence, symptoms, diagnosis, and treatment of systemic giant cell arteritis, with special attention to extracranial involvement. These case reports may broaden the knowledge of the diverse manifestations of giant cell arteritis and of its systemic character with widespread vascular involvement.
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PMID:Giant cell arteritis (Horton's disease) of the axillary artery--case reports. 265 5

Giant cell arteritis (GCA) may present as pyrexia of unknown origin with profuse night sweats, pain on mastication, headache, pain in the region of the temporal arteries, polymyalgia rheumatica, myocardial infarction or dissecting aortic aneurysm. Few cases with pulmonary involvement have been described. We report a patient with temporal arteritis preceded by pulmonary vascular disease.
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PMID:Giant cell arteritis with pulmonary involvement. 316 24

A number of ocular and nonocular conditions may produce an acutely painful eye or orbit. A careful history and physical examination with special attention to the cornea, sclera, fundus, and cranial nerves will usually delineate the etiology of the pain. In particular, certain life- or vision-threatening conditions such as leaking internal carotid aneurysm, cavernous sinus thrombosis, orbital cellulitis, acute narrow-angle glaucoma, and temporal arteritis must be kept in mind.
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PMID:The acute painful eye. 327 85

100 patients, from three internal medicine departments, were the subject of a retrospective study concerning the clinical manifestations and the evolution of Horton's disease. The mean age is 71 years, with a 2/1 female predominance. A temporal artery biopsy was obtained in all cases. Besides the prevalence of clinical symptoms (headaches: 80 p. cent; weight loss: 78 p. cent; fever: 65 p. cent; local inflammation: 52 p. cent, frequent pseudo-polyarthritis: 40 p. cent and sometimes severe ocular localizations (11 p. cent blindness), other signs should be emphasized: muscular pain (49%), skin hyperesthesias (37%), painful jaw (33%), etc. The inflammatory syndrome dominates the biological picture (96%); the alkaline phosphatases are increased in 37 p. cent of cases. Temporal artery biopsy was positive in 82 p. cent of cases, which confirms the excellent sensitivity of this test, preceded by a Doppler study in only 28 cases. Extension of the inflammatory process to the large vessels was demonstrated 8 times, on clinical data. Finally, the mean length of the steroid treatment was two years with 14 relapses and 8 deaths.
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PMID:[Clinical and developmental aspects of Horton's disease. Retrospective study of 100 cases]. 328 62

Jaw claudication (angina masticatorica) is one of the best known signs of giant cell arteritis (Horton's arteritis). Other symptoms are pain, swelling, redness and necrosis of the face, mouth, and nasal mucosa (ulcerous pharyngitis, glossitis) leading to disturbances in swallowing. In rare cases there are alterations of smelling and hearing. The knowledge of such non-characteristic symptoms can be of diagnostic importance in cases of Horton's arteritis without local signs in the temporal area, visual failure or polymalgia rheumatica.
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PMID:[Symptoms and findings of giant cell arteritis in the area of the ear, nose, and throat]. 332 Jun 47


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