Giant Cell Temporal Arteritis

The criteria of the American College of Rheumatology for the diagnosis of giant cell arteritis (Fig. 7.4) include at least three of the following: (1) age at disease onset >50 years, (2) new onset of headache, (3) claudication of jaw or tongue, (4) tenderness of the temporal artery on palpation or decreased pulsation, (5) erythrocyte sedimentation ratio >50 mm/h and

Temporal Arteritis
Figure 7.2 a-f

Primary angitis of central nervous system (proven by biopsy) in a 60-year-old woman with dizziness and speech difficulties. a T2-weighted image shows hyperintense lesions in the bilateral tempo-occipital cortices (arrows). b FLAIR image shows hyperintense lesions in the bilateral tempo-occipital cortices (arrows).c DW image shows slightly high signal in the lesions (arrow) with increased ADC (d), mainly representing vasogenic edema (arrow). e DSA shows multiple focal stenoses of distal branches of left middle cerebral arteries (arrows). f Two-month follow-up T2-weighted image shows no infarction in the bilateral tempo-occipital areas. (From [49])

Bilateral Cortices

Figure 7.3 a-g

Corona Radiata Blood Supply

Figure 7.3 a-g

Primary angitis of central nervous system (proven by biopsy) in a 35-year-old woman with right hemiparesis. a, b T2-weighted image shows hyperintense lesions in the left internal capsule (arrow in a) and left side of the pons (arrow in b). c DW image shows slightly high signal in the left corona radiata, indicating subacute infarction. a T2-weighted image shows hyperintense lesions in the bilateral tempo-occipital cortices (arrow). d ADC map shows increased ADC in this lesion (arrow). e DW image simultaneously shows very high signal in the left side of the pons, indicating acute infarction (arrow). f ADC map shows decreased ADC in this lesion (arrow). g MR angiography shows stenosis in the left middle cerebral and posterior cerebral arteries (arrows). (From [49])

Dsa Digital Subtraction Angiography

Figure 7.3 h-j h, i Digital subtraction angiography (DSA) confirms the stenosis in the left middle cerebral (arrow in h) and posterior cerebral arteries (i) (arrows in i).j Pathological specimen by meningeal biopsy shows infiltration of the vessel walls with lymphocytes and multinucleated giant cells, with intramural granulomatous tissue formation (arrows). (From [49])

Figure 7.3 h-j h, i Digital subtraction angiography (DSA) confirms the stenosis in the left middle cerebral (arrow in h) and posterior cerebral arteries (i) (arrows in i).j Pathological specimen by meningeal biopsy shows infiltration of the vessel walls with lymphocytes and multinucleated giant cells, with intramural granulomatous tissue formation (arrows). (From [49])

Giant Cell Temporal Arteritis

(6) temporal artery biopsy showing vasculitis with multinucleated giant cells.

Giant cell arteritis is probably a T cell-mediated vasculitis and it can affect medium to large arteries. The superficial temporal, vertebral and ophthalmic arteries are more commonly involved than the internal carotid arteries,while the intracranial arteries are rarely involved (Fig.7.4) [18].Abrupt and irreversible visual loss is the most dramatic complication of giant cell arteritis,while a TIA and stroke are rare (7%),but when present most often involve the vertebrobasilar territory. Steroids are effective, and giant cell arteritis is usually self-limited and rarely fatal.

Giant Cell Arteritis ImagesGiant Cell Arteritis

Figure 7.4 a-d

Giant cell arteritis (proven by biopsy) in a 48-year-old woman with visual loss. a T2-weighted image shows hyperintense lesions in the bilateral parieto-occipital cortices and right frontal deep white matter (arrows). b DW image shows these lesions as high signal intensity, representing acute infarcts (arrows). c DSA of the left subcla-vian artery shows stenoses of the left vertebral and subclavian arteries (arrows).d DSA of the left vertebral artery shows extensive multifocal arterial stenoses (arrows). (From [49])

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  • JIMMY
    How to embed a temporal artery?
    6 years ago

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