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Updated: Aug 18 2019

Large Vessel Vasculitides

  • Snapshot
    • A 62-year-old woman presents to her primary care physician due to an unremitting headache. She says she has been having this headache for the last few days and is nonresponsive to ibuprofen. Her headache is left-sided and affects the temporal region of her head. She notes to having jaw pain when chewing food or brushing her teeth. On physical exam, there is tenderness to palpation of the left temporal artery. (Giant cell temporal arteritis)
  • Large Vessel Vasculitides
      • Large Vessel Vasculitides
      • Type
      • Pathology
      • Presentation
      • Studies
      • Treatment
      • Giant cell temporal arteritis
      • Intimal thickening
      • Medial granulomatous inflammation leading to elastic lamina fragmentation
        • may be focally found, requiring at least a 1 cm segment of the temporal artery
      • Elderly (> 50 years of age) patient with aheadache in the temporal region, often worse with chewing
      • Pain upon palpation of the temporal artery
      • ~50% will present withjaw claudication
      • Abnormalities in vision may occur (e.g., diplopia or blindness) when the ophthalmic artery is involved
      • May be associated with polymyalgia rheumatica
      • ↑ erythrocyte sedimentation rate (ESR)
      • Temporal artery biopsy
      • High-dose corticosteroids
        • must be administered immediately in order to prevent blindness
      • Takayasu arteritis
      • Transmural fibrous thickening of the aortic arch and major vessels
      • Classic in Japanese women who are < 40 years of age
      • Weak pulse and decreased blood pressure in the upper extremities
      • Fatigue, malaise, weight loss, and arthralgias
      • ↑ erythrocyte sedimentation rate (ESR)Angiography or MRA
      • High-dose corticosteroids
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