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Vascular Sonography
Temporal Arteritis pathology
| Term | Definition |
|---|---|
| Temporal Arteritis | most common form of systemic inflammatory vasculitis in adults. aka horton's disease |
| Giant cell arteritis (GCA), or temporal arteritis | is a panarteritis most common in older people. extracranial branches of the carotid artery are commonly affected |
| the most dreadful complication | Blindness but can be prevented by high index of suspicion and timely treatment |
| what does the temporal arteritis name indicate? | indicates that the Temporal Artery, which runs over the temple near the ear, is affected. Other arteries such as the Aorta, may be affected, especially those that supply the head and eyes. |
| Giant Cell Arteritis, reflects? | reflects the type of inflammatory cell that is involved (as seen on biopsy). |
| Signs and symptoms of Temporal arteritis in physical exam | • Palpation of the head reveals prominent temporal arteries with or without pulsation. • The temporal area may be tender. • Decreased pulses may be found throughout the body. |
| Signs and symptoms of temporal arteritis in laboratory tests | • Erythrocyte Sedimentation Rate (ESR), an inflammatory marker, > 60 mm / hour (normal 10 - 40 mm / hour), but may be normal in approximately 20% of cases. • C-reactive protein also commonly elevated. platelets may be elevated |
| what is the gold standard for diagnosing GCA? | biopsy |
| Types of investigations for GCA | biopsy- gold standard unilateral biopsy- biopsy of 1.5-3cm length is 85-90% sensitive imaging studies - artery with halo sign & contrast enhanced brain MRI and CT is generally negative |
| GCA Key features | f >55yrs predominantly affected, severe throbbing headache, fever, jaw and chewing pain artery red, tender, firm, swollen and tortuous blindness, polymyalgia (multiple muscle pain) weakness and pain in shoulder or pelvic gridles |
| what causes a good response to early treatment? | corticosteroids |
| what develops in 50% of patients? | • Disturbances of vision or sudden blindness due to involvement of the ophthalmic artery |
| How long should the biopsy be? | at least 3cm long |
| Dose of Steroid | Prednisone is lowered after 2-4 weeks and slowly tapered over the course of 9-12 months |
| T or F: . Oral steroids are at least as effective as intravenous steroids | true |
| what is the only instance where intravenous steroids offer significant benefit over oral steroids | except in the treatment of acute visual loss |
| The anatomical route of the temporal artery can be presented in | longitudinal and transverse view |
| Where is stenosis presented? | -blood flow is at least double compared w/ flow velocity recorded in the area right before the sampled increase -post stenotic turbulence -low blood flow velocities at arterial segment right after |
| Measurements of the longitudinal diameter of the systolic lumen, wall thickness, and peak systolic velocities should be performed at the following three anatomical sites: | (a) trunk: in front of the tragus, (b) parietal ramus: 15 mm distal of bifurcation (c) frontal ramus: 25 mm distal of bifurcation |
| When a stenosis is present at these points, where should measurements should be performed? | performed 3–5 mm proximal also to show the velocity increase |
| How does GCA present in ultrasound images? | Hypoechogenic ring areas, generally appear around the lumen of the temporal artery and can often be detected in one or more sites unilaterally or bilaterally. These are defined as halos. |
| how do you perform halo measurements? | Measurements of the halo length and diameter in longitudinal and transverse planes should be performed. |
Created by:
jcazares10
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