Temporal arteriography

Giant cell (cranial) arteritis: a clinical review

Giant cell arteritis is a disease of the elderly which is more common than previously recognized. It is important to be aware of this condition because treatment effectively relieves symptoms and prevents serious complications. The disease is suggested when an elderly patient complains of constitutional symptoms, headache, jaw claudication, or the musculoskeletal manifestations of polymyalgia rheumatica. Abnormalities in temporal arteries or other cranial arteries, or evidence of large vessel involvement may be detected by physical examination. A markedly elevated sedimentation rate in association with other clinical features of the disease strongly suggests giant cell arteritis, but a biopsy should be performed to confirm the diagnosis. Corticosteroid therapy should be started promptly in high doses in order to prevent blindness. Prolonged treatment with lower dose corticosteroids is generally necessary for up to 1 to 2 years, and sometimes longer, for continued symptomatic relief. Long-term follow-up of treated patients has demonstrated no detectable effect on survivorship.

Combined temporal arteriography and selective biopsy in suspected giant cell arteritis

Superficial temporal arteriography was studied by selective biopsy of abnormal arterial segments and random biopsy of the main stem in 33 patients with clinically supected giant cell arteritis. Of the total of 33 temporal arteriograms 9 showed definite abnormalities (7 in the periphery and 2 in the main stem). Selective biopsy of the 7 peripheral abnormal segments showed arteritis in only 2, narrowing of the vessels in the remainder being due to atheroma (3) and fibrointimal thickening (2)--that is, 5 'false positives' for temporal arteritis on arteriography. Histological evidence of arteritis was found in 9 patients, only 5 of whom had clearly abnormal arteriograms--that is, 4 'false negatives'. Thus temporal arteriography appears to have low sensitivity for identifying arteritic lesions and also frequently gives 'false positive' results. It is concluded that temporal arteriography is not a satisfactory alternative to biopsy, and that its value as an adjunct to selective biopsy is limited because of its frequent failure to detect lesions found histologically.

Temporal arteriography. Analysis of 21 cases and a review of the literature

To define the role of temporal arteriography in the diagnosis of giant-cell arteritis, the results of temporal arteriography in 21 patients who had temporal artery biopsies were reviewed. Abnormal angiography was found in all patients with biopsy-proven giant-cell arteritis, in some patients with polymyalgia rheumatica and normal biopsy, and in some patients with neither polymyalgia rheumatica nor giant-cell arteritis. No pattern of angiographic abnormality typical for giant-cell arteritis could be found. Results suggest temporal arteriography is a sensitive but nonspecific procedure in the diagnosis of giant-cell arteritis and must be coupled with biopsy of angiographic abnormalities for confirmation of diagnosis.

Ischemic chiasmal syndrome

Twenty-two patients with ischemic chiasmal syndrome (ICS) have been examined by means of magnification angiography and polytomographic encephalography. The causes of ICS may be divided into 5 categories: (1) mechanical compression of the chiasm by ectatic redundant anterior cerebral arteries, (2) atherosclerotic vascular occlusions, (3) optochiasmal arachnoidal fibrosis, (4) various forms of arteritis especially giant cell (cranial) arteritis, and (5) post-partum pituitary necrosis associated with ICS. The most common cause of ICS appears to be optochiasmal arachnoiditis which occasionally developed some time after a craniotomy and radiation therapy for pituitary or other juxta-sellar tumors; similar fibrotic change may develop following steroid treatment of granulomatous lesions.