Temporal arteritis

Definition

Temporal arteritis is inflammation and damage to blood vessels that supply the head area, particularly the large or medium arteries that branch from the neck.

If the inflammation affects the arteries in your neck, upper body and arms, it is called giant cell arteritis.

Alternative Names

Arteritis - temporal; Cranial arteritis; Giant cell arteritis

Causes, incidence, and risk factors

Temporal, giant cell, and cranial arteritis occur when one or more arteries become inflammed and die.

It most commonly occurs in the head, especially in the temporal arteries that branch off from a blood vessel in the neck called the carotid artery. However, the condition can be a body-wide (systemic) disorder, affecting many medium-to-large sized arteries anywhere in the body.

The cause is unknown but is believed to be partly due to a faulty immune response. The disorder has been associated with severe infections and high doses of antibiotics.

The disorder may develop along with or after polymyalgia rheumatica. Giant cell arteritis is seen almost exclusively in those over 50 years old, but may occasionally occur in younger people. It is rare in people of African descent. There is some evidence that it runs in families.

Symptoms

• Excessive sweating
• Fever
• General ill feeling
• Jaw pain, intermittent or when chewing
• Loss of appetite
• Muscle aches
• Throbbing headache on one side of the head or the back of the head
• Scalp sensitivity, tenderness when touching the scalp
• Vision difficulties
  • Blurred vision
  • Double vision
  • Reduced vision (blindness in one or both eyes)
• Weakness, excessive tiredness
• Weight loss (more than 5% of total body weight)

Additional symptoms that may be associated with this disease:

• Bleeding gums
• Face pain
• Hearing loss
• Joint stiffness
• Joint pain
• Mouth sores

About 40% of people will have other nonspecific symptoms such as respiratory complaints (most frequently dry cough) or weakness or pain along many nerve areas. Rarely, paralysis of eye muscles may occur. A persistent fever may be the only symptom.

Signs and tests

The doctor will examine your head. Touching the head may show that the scalp is sensitive and has a tender, thick artery on one side. The affected artery may have a weak pulse or no pulse.

Blood tests may include:

• Hemoglobin or hematocrit -- may be normal or low
• Liver function tests -- may be abnormal with high levels of alkaline phosphatase
• Sedimentation rate and C-reactive protein -- almost always very high

Blood tests cannot specifically diagnose this condition. A biopsy and examination of tissue from the affected artery confirm the diagnosis in most cases.

Treatment

The goal of treatment is to reduce tissue damage that may occur because of lack of blood flow.

Your doctor may prescribe corticosteroids to reduce inflammation. Corticosteroid treatment may be started even before a biopsy confirms the diagnosis. Aspirin may also be recommended.

Medications that suppress the immune system are occasionally prescribed.

Support Groups

Expectations (prognosis)

Most people make a full recovery, but long-term treatment (for 1 to 2 years or longer) may be needed. The condition may return at a later date.

Complications

Possible complications, especially if not treated properly or promptly, include:

• Sudden vision loss or eye muscle weakness
• Damage to other blood vessels in the body
• TIA or stroke

Side effects from steroid or immune-suppressing medications may also occur.

Calling your health care provider

Call your health care provider if you have persistent throbbing headache and other symptoms of temporarl arteritis.

Prevention

There is no known prevention.

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References

Paget SA, Spiera RF. Polymyalgia Rheumatica and Temporal Arteritis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 292.