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

Seven patients of temporal arteritis with eye involvement have been presented. These cases represent a spectrum of disease from intermittent diplopia with minimal 6th nerve weakness through mild retinal ischemia with recovery to permanent bilateral blindness. Temporal arteritis should be suspected when any form of ocular ischemia is suspected by history or found on examination of an elderly person. An early diagnosis may protect the vision in both eyes if vision is normal at the time of diagnosis. If vision in one eye is decreased because of ischemia, the vision in the other eye can usually be retained if proper therapy is instituted. Furthermore, adequate therapy may even result in improvement in vision in the involved eye. Patients with biopsy proven temporal arteritis should be continued on steroid therapy until the active disease is quiescent. Inactivity should be determined by carefully monitoring the ESR while steroids are being tapered. If the ESR rises, it is indicative of continued inflammation and if steroids are not continued, the eyes remain at risk as seen in Case 5. If the ESR remains elevated for a year or more despite continuation of high steroid levels, consideration should be given to repeating the temporal artery biopsy. Temporal arteritis should be considered in the differential diagnosis of any multisystem disease in older patients. Even central nervous system involvement may occur concomitantly, since the intracranial vessels are not immune from the disease process. Tuberculosis, systemic syphilis and more recently the collagen vascular diseases have been dubbed the "great imitators" and "the protean diseases." We suggest that the same terminology can be applied to temporal arteritis. Temporal arteritis can affect any organ. Moreover, there is a wide spectrum of variation in the degree of involvement of any particular tissue as illustrated by these 7 cases of ocular involvement.
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PMID:Temporal arteritis: a spectrum of ophthalmic complications. 118 Apr 60

A 63-year-old man presented six days after the sudden onset of horizontal double vision. His left eye became divergent two days later. On initial examination he had bilateral internuclear ophthalmoplegia with weakness of adduction and abducting nystagmus. Convergence was weak but there were no other neuro-ophthalmic signs. Constitutional signs included confusion and unsteadiness on his feet. A provisional diagnosis of arteritis was made. His ESR was 92 mm/h and a superficial temporal artery biopsy confirmed the diagnosis of giant cell arteritis. After two weeks or oral prednisolone his eye movements returned to normal. There have been no further relapses. This would appear to be a unique presentation of giant cell arteritis. The causes of internuclear ophthalmoplegia are discussed along with a review of the ocular and neuro-ophthalmic signs of giant cell arteritis.
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PMID:Bilateral internuclear ophthalmoplegia--an unusual initial presenting sign of giant cell arteritis. 276 84

A 79-year-old woman was admitted to hospital complaining of chest pain, increasing weakness, anorexia, hoarseness, headache and discomfort in the throat and jaws while eating. Physical examination, chest x-rays, serial electrocardiograms and cardiac enzymes were unremarkable. After admission she developed weakness and numbness in the left leg with urinary retention, decreased sensation to touch, weakness, increased tone, absent deep tendon reflexes and a positive Babinski sign on the left. Zeta sedimentation rate was markedly elevated at 0.63. Computerized tomographic head scan, myelography, echocardiography, barium swallow and meal, immunoglobulins, electrophoresis and other laboratory investigations were unremarkable. Repeat sedimentation rate was still markedly elevated three weeks later. A temporal artery biopsy confirmed the diagnosis of temporal or giant cell arteritis. Prednisone, 60 mg daily, was started.
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PMID:Acute chest pain in an elderly woman. 337 98

We describe a case of histologically proven giant cell arteritis (GCA) in a 62-year-old woman who initially presented with upper limb girdle pain and weakness, and intermittent claudication. Clinical improvement was obtained with oral prednisolone. She subsequently developed a photosensitive rash and was diagnosed as having systemic lupus erythematosus. The features of the two conditions and the possibility of an association are discussed.
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PMID:Giant cell arteritis and systemic lupus erythematosus. 340 55

Temporal headache, blindness, and polymyalgia rheumatica are well-recognized manifestions of giant cell arteritis. However, the disease may present in less evident fashion as shown by 30 of 74 patients with biopsy-proven giant cell arteritis whose predominant complaint was not one ot these cardinal symptoms. For this group of 30, the main problem was fever in 12 patients, anorexia, weight loss, and elevated serum alkaline phosphatase level suggesting an occult malignancy in 7, and unexplained anemia in 3. Four patients had a neurologic syndrome; 2 had diplopia and 2 acute weakness of one arm. Claudication was the chief complaint of 4 patients, involving the leg in 1, the arm in 1, and the jaw in 2. All patients responded well to steroid therapy.
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PMID:Presentation of occult giant cell arteritis. 738 40

A 55-yr-old Palestinian man was admitted with a 1-month history of bi-temporal headache, proximal weakness and myalgia in the lower limbs. Both temporal arteries were swollen and tortuous. There was a moderate degree of cholestatic hepatic dysfunction. Temporal artery biopsy showed typical features of giant cell arteritis. Light microscopic examination of the liver showed no significant abnormality while electron microscopic (EM) examination revealed ultrastructural damage to the bile canaliculi. The patient improved dramatically on steroid therapy with normalization of cholestatic dysfunction. EM examination of a repeat liver biopsy 8 months later showed complete reversal of the biliary ultrastructural damage. The pathogenesis of the biliary injury remains uncertain.
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PMID:Biliary ultrastructural changes in the liver in a case of giant cell arteritis. 816 83

Horton giant cell arteritis can present with an atypical clinical picture that often resembles other diseases. In the case described below, the patient initially demonstrated clinical and laboratory evidence of a Candida albicans sepsis, and therefore we started antimycotic treatment with amphotericin B. Because of an adverse reaction to that drug, we added parenteral steroids before every administration of the antimycotic which led to an unexpected improvement of symptoms. This result caused us to reconsider some clinical aspects that could have been interpreted also as vasculitis, in particular for a giant cell arteritis: throbbing temporal headache, diffuse weakness, important rise in ESR, myoarthralgias. We performed a biopsy of the temporal artery that confirmed our diagnosis.
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PMID:[An atypical presentation of a case of Horton's giant-cell arteritis]. 868 82

We have noticed significant changes in the clinical presentation in patients diagnosed with temporal arteritis in Israel between 1980-1992 compared to patients diagnosed prior to 1977. At the time of diagnosis 57% of the patients were older than 75 years, compared to only 23% within this age group in the previous period. There was an increase in the number of nonspecific and unusual presenting symptoms such as weakness, respiratory and neurological symptomatology, and a decreased proportion of patients presenting with the "classical" manifestation such as headaches, temporal tenderness and visual symptoms. The time from presentation to diagnosis was shortened significantly. It is suggested that these changes are largely due to the increasing awareness among physicians to the various manifestations of this conditions.
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PMID:Trends in the clinical presentation of temporal arteritis in Israel: reflection of increased physician awareness. 945 25

Polymyalgia rheumatica is a clinical syndrome of proximal muscle pain in older patients that often presents a diagnostic challenge because of the large differential diagnosis, lack of definitive diagnostic criteria, and relatively frequent "atypical" clinical findings, such as peripheral synovitis, distal extremity pain, normal erythrocyte sedimentation rate, and mild weakness. Despite an extensive differential diagnosis that includes endocarditis and steroid-responsive malignant neoplasms, routine laboratory testing should be limited, and a low-dose corticosteroid trial is useful as the final step in the evaluation. The clinical overlap with seronegative rheumatoid arthritis is striking, suggesting that these diagnoses may represent different presentations of a similar disease process. While concurrent asymptomatic temporal arteritis is common, there are no data to support obtaining a temporal artery biopsy in patients with pure polymyalgia rheumatica symptoms.
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PMID:Diagnostic dilemmas in polymyalgia rheumatica. 943 85

The clinical and histopathological details of a patient who succumbed to giant cell arteritis (GCA) of the cervical radicular vessels are described. The initial clinical presentation, with diaphragmatic weakness, has not previously been reported. Normal inflammatory indices and the unusual presentation prevented diagnosis during life, but GCA should be considered in the differential diagnosis of any unexplained neuropathic or radiculopathic syndrome, as corticosteroid therapy may lead to recovery. This is the first account of the pathological findings in cervical radiculopathy associated with GCA.
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PMID:Giant cell arteritis of the cervical radicular vessels presenting with diaphragmatic weakness. 1084 98


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