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Temporal arteritis  

Temporal arteritis occurs mainly in white women in their late life.  Autoimmune processes presumably provide the cause.

Clinical suspicion

New, severe, sustained, steady or throbbing headache most often located in the temporal region of the scalp and accompanied by a tender, nodular, or incompressible artery in the area. Head pain also may affect the masseter or sterno­cleidomastoid muscles, occasionally as the chief symptom.

Associated symptoms may include malaise, fatigue, weight loss, low-grade fever, and proximal myalgia affecting the pectoral or pelvic girdle areas (polymyalgia rheumatica). The erythrocyte sedimentation rate (ESR) usually rises to 60 mm/hr or more.

Diagnosis

Firm diagnosis requires a biopsy.

Pathological examination of the offending temporal artery usually shows an inflammatory response, often with partial or complete occlusion of the lumen.

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Treatment

Temporal arteritis represents a medical emergency, since delaying proper treatment increases the risk of retinal artery occlusion, thereby producing partial or com­plete functional loss of vision.

High dose corticosteroids in the presence of a probable clinical diagnosis. Remarkable resolution within 24hrs is the rule.

Follow up twice monthly for symptoms and ESR to detect relapse.

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