Temporal Artery Biopsy |
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Performed to diagnose also known as Temporal Arteritis, because the temporal artery is often involved. The temporal artery courses up the temples, just in front of the ears. The biopsy, done under local anesthesia, is performed by making a small incision just above the hairline (sometimes shaving a small area of hair is required). The procedure is extremely well–tolerated by patients. Within several weeks, there is usually little or no sign that a biopsy was done. Complications of temporal artery biopsies are extremely rare. Sometimes, to increase the diagnostic yield, both temporal arteries (i.e., the ones on each side of the head) are biopsied.
Alternate Names: Arteritis - Temporal, Cranial Arteritis, Giant Cell Arteritis
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Overview, Causes, & Risk Factors |
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Giant cell, cranial, or temporal arteritis occurs when there is inflammation and necrosis (death of the tissues) of one or more arteries. It most commonly occurs in the head, especially in the temporal arteries that branch from the carotid artery of the neck. However, it can be systemic, affecting multiple medium-to-large sized arteries anywhere in the body.
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The cause is unknown but is assumed to be, at least in part, an effect of the immune response. The disorder has been associated with severe infections and high doses of antibiotics. The symptoms occur because of inflammation.
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The disorder may exist independently or may coexist with or follow polymyalgia rheumatica(a disorder characterized by abrupt development of pain and stiffness in the pelvis and shoulder muscles). About 25% of people with giant cell arteritis also experience polymyalgia rheumatica.
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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.
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Symptoms & Signs
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• fever
• a throbbing headache on one side of the head or the back of the head
• scalp sensitivity, tenderness when touching the scalp
• jaw pain, intermittent or when chewing
• vision difficulties
o blurred vision, double vision
o reduced vision, blindness in one or both eyes
• weakness, excessive tiredness
• a general ill feeling
• a loss of appetite
• weight loss (more than 5% of total body weight)
• muscle aches
• excessive sweating
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Additional symptoms that may be associated with this disease:
• mouth sores
• joint stiffness
• joint pain
• hearing loss
• bleeding gums
• face pain
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Diagnosis & Tests
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When the doctor feels (palpates) the head, the scalp is sensitive and often shows a tender, thick artery on one side of the head. The affected artery may have a weakened pulse or no pulse. About 40% of people will have other nonspecific symptoms such as respiratory complaints (most frequently dry cough) or mononeuritis multiplex (weakness and/or pain of multiple individual nerve groups). Rarely, paralysis of eye muscles) may occur. A persistant fever may be the only symptom.
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Treatment
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The goal of treatment is to minimize irreversible tissue damage that may occur because of lack of blood flow (ischemia).
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Corticosteroids such as Prednisone are commonly prescribed to reduce inflammation.Corticosteroid treatment may be started even before a biopsy confirms the diagnosis (to reduce the risk of complications). Aspirin may be recommended in addition to corticosteroids. Medications that suppress the immune system (such as cyclophosphamide or methotrexate) are occasionally prescribed to try to minimize the dose of steroids needed.
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Prognosis (Expectations)
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Most people make a full recovery, but prolonged treatment, for 1 to 2 years, may be necessary. Recurrence is possible for several years.
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