non neuro causes of headache: temporal arteritis

Question 1

define

Answer 1

Temporal arteritis is large vessel vasculitis which overlaps with polymyalgia rheumatica (PMR). Histology shows changes which characteristically ‘skips’ certain sections of affected artery whilst damaging others.

Question 2

s/s

Answer 2

• typically patient > 60 years old
• usually rapid onset (e.g. < 1 month)
• headache (found in 85%)
• jaw claudication (65%)
• visual disturbances secondary to anterior ischemic optic neuropathy
• tender, palpable temporal artery
• features of PMR: aching, morning stiffness in proximal limb muscles (not weakness)
• also lethargy, depression, low-grade fever, anorexia, night sweats

Question 3

ix

Answer 3

Investigations

• raised inflammatory markers: ESR > 50 mm/hr (note ESR < 30 in 10% of patients). CRP may also be elevated
• temporal artery biopsy: skip lesions may be present
• note creatine kinase and EMG normal

Question 4

rx

Answer 4

Treatment

high-dose prednisolone - there should be a dramatic response, if not the diagnosis should be reconsidered

urgent ophthalmology review. Patients with visual symptoms should be seen the same-day by an ophthalmologist. Visual damage is often irreversible