Updated: 8/18/2019

Large Vessel Vasculitides

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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 a headache in the temporal region, often worse with chewing
  • Pain upon palpation of the temporal artery
  • ~50% will present with jaw 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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(M1.CV.13.9) A 69-year-old woman presents to her primary care physician complaining of a new-onset, left-sided, throbbing headache that has lasted for several days. She reports that the pain is worsened by eating. Which of the following is a complication of this condition if not treated promptly? Tested Concept

QID: 101673
1

Skin nodules

0%

(0/21)

2

Intestinal ischemia

0%

(0/21)

3

Monocular blindness

81%

(17/21)

4

Myocardial infarction

0%

(0/21)

5

Ischemic stroke

14%

(3/21)

M 2 E

Select Answer to see Preferred Response

(M1.CV.12.63) A 68-year-old Caucasian male complains of severe headache and pain while chewing. Upon examination, he is found to have a left visual field deficit. Laboratory results show elevated erythrocyte sedimentation rate. Which of the following drugs would be the best choice for treatment of this patient?
Tested Concept

QID: 100579
1

Propranolol

4%

(1/25)

2

Prednisone

84%

(21/25)

3

Sumatriptan

4%

(1/25)

4

Pilocarpine

0%

(0/25)

5

Clopidogrel

8%

(2/25)

M 3 D

Select Answer to see Preferred Response

(M1.CV.12.69) A 30-year-old Japanese female presents with flu-like symptoms and weak pulses in her upper extremities. An angiogram reveals granulomatous inflammation of the aortic arch. Which of the following disease processes is most similar to this patient's disease? Tested Concept

QID: 100585
1

Temporal arteritis

56%

(14/25)

2

Polyarteritis nodosa

0%

(0/25)

3

Kawasaki disease

36%

(9/25)

4

Buerger's disease

0%

(0/25)

5

Infectious vasculitis

8%

(2/25)

M 1 D

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VIDEOS (1)
Topic COMMENTS (16)
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