Temporal arteritis or giant cell arteritis is a systemic disorder of unknown cause characterized by an inflammatory obliterative arteritis particularly, but not exclusively involving branches of the external carotid and ophthalmic arteries. It is well known as a cause of anterior ischemic optic neuropathy and less well recognized as a cause of ophthalmoplegia. The most common initial symptom is headache, often accompanied by diffuse aches and pains (polymyalgia rheumatica). Other common symptoms include jaw claudication, fever, anemia, and weight loss.

The headache of temporal arteritis may clearly involve more than the temporal area and include pain in the temporal, frontal, vertex and occipital regions. The headache is characterized by gradual onset, progressing to a diffuse, often severe, aching. The headache may be intermittent, but usually becomes a prominent, if not daily, feature of patients with the disorder. The headache usually is constant and perceived as superficial in the scalp.There may be exquisite tenderness of the scalp and blood vessels particularly in the temporal region. The headache is usually worse at night and may be especially aggravated by exposure to cold.

Sixty-five percent of patients are women with the average age at onset of 70 (range 50-85). It is a common disorder and must be actively sought in any headache patient presenting after the age of 50 particularly in those with systemic symptoms.

An elevated sedimentation rate has been considered by some indispensable in diagnosing temporal arteritis. Without an elevated sedimentation rate, even in patients with a classic history and clinical findings, the diagnosis might be abandoned without proceeding to a temporal artery biopsy.

 

 

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