Temporal Arteritis

Temporal Arteritis is also known as Giant Cell, Cranial, or Granulomatous Arteritis.  It is the most common Vasculititis in the head and neck.  In 50% of cases it is comorbid with Polymyalgia Rheumatica (PMR).  It will often present with anemia, depression, morning stiffness and low grade fever for more than a month.  It is more common in Women and more prevalent over 60.  The vasculitis leads to small vessel ischemia and most notably visual loss.  Patients will often have intense pulsatile cephalagia, hyperalgesia or the scalp, jaws and tongue.  Masticatory claudication is very prevalent.   Odynophagia, odynophonia, anorexia, fever, and streaking erythema over the temporal artery are very common.  The ESR is usually over 40, and often over 100.  Patients will often have high immunoglobulin counts and low albumin.  A third of patients will have othamologic involvement.  Early steroids are indicated and a six centimeter segment for biopsy is taken as there are skip lesions in up to 30% of patients.  If the biopsy is negative and your clinical suspicion is high, might perform a biopsy on the contralateral side.  If the diagnosis is made, you may have to treat with steroids up to 2 years.  You never want to misdiagnose as migraines or treat with ergotomines, as the risk of blindness exists.