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Doğan R, Saygı M, Birdal O, Gülcü O, Güler GB, Şeker MC, Atae MY, Güler A, Gökçe K, Şen D, Bulut M, Yücel E, Özkalaycı F, Karagöz A, Tanboğa İH. Relation of thumb-palm test with ascending aortic diameter and aortic regurgitation. Acta Cardiol 2024:1-9. [PMID: 38357910 DOI: 10.1080/00015385.2024.2313934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Remziye Doğan
- Cardiology, Hisar İntercontinental Hospital, İstanbul, Turkey
| | - Mehmet Saygı
- Cardiology, Hisar İntercontinental Hospital, İstanbul, Turkey
| | - Oğuzhan Birdal
- Faculty of Medicine, Cardiology, Erzurum Atatürk University, Erzurum, Turkey
| | - Oktay Gülcü
- Cardiology, Erzurum Training and Research Hospital, İstanbul, Turkey
| | - Gamze Babur Güler
- İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology, İstanbul, Turkey
| | - M Cüneyt Şeker
- Faculty of Medicine, Cardiology, Erzurum Atatürk University, Erzurum, Turkey
| | - M Younus Atae
- Faculty of Medicine, Cardiology, Erzurum Atatürk University, Erzurum, Turkey
| | - Arda Güler
- İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology, İstanbul, Turkey
| | - Kaan Gökçe
- İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology, İstanbul, Turkey
| | - Doğan Şen
- Cardiology, İstanbul Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Muhammed Bulut
- Cardiology, İstanbul Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Enver Yücel
- Cardiology, İstanbul Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Flora Özkalaycı
- Faculty of Medicine, Cardiology, İstanbul Nişantaşı University, İstanbul, Turkey
| | - Ali Karagöz
- Cardiology, İstanbul Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
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Lyons HS, Quick V, Sinclair AJ, Nagaraju S, Mollan SP. A new era for giant cell arteritis. Eye (Lond) 2020; 34:1013-1026. [PMID: 31582795 PMCID: PMC7253415 DOI: 10.1038/s41433-019-0608-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 12/15/2022] Open
Abstract
The landscape of the investigation and management of giant cell arteritis (GCA) is advancing. In this review we will outline the recent advances by searching the current English literature for relevant articles using key words of giant cell arteritis, temporal arteritis, Horton's disease, investigation, and treatment. Delay in diagnosis, diagnostic uncertainty and glucocorticoid (GC) morbidity are among the highest concerns of clinicians and patients in this disease area. The positive news is that fast track pathways, imaging techniques and new therapies are emerging for routine management of GCA. Future directions for intervention in the treatment paradigm will be discussed.
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Affiliation(s)
- H S Lyons
- Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - V Quick
- Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, UK
| | - A J Sinclair
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S Nagaraju
- Department of Histopathology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK
| | - S P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK.
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3
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Endovascular treatment of critical lower limb ischemia caused by giant cell arteritis. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:31-34. [PMID: 30627690 PMCID: PMC6322075 DOI: 10.1016/j.jvscit.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/25/2018] [Indexed: 11/23/2022]
Abstract
Giant cell arteritis (GCA) is a well-known cause of cranial vasculitis often presenting with headache and jaw claudication. Here we report the case of a woman suffering GCA who presented with critical lower limb ischemia. Despite best medical therapy, she developed progressive calf claudication and ulceration of the right foot. The findings on workup were highly suggestive of GCA involving the superficial femoral artery. The limb was successfully revascularized with angioplasty and placement of a drug-eluting stent. GCA is an important cause of lower limb ischemia and should be considered in patients without evidence of atherosclerosis. Endovascular intervention is a feasible treatment of critical limb ischemia due to GCA and has been shown to be safe in this case.
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Pedro F, Abuowda Y, Craveiro N, Oliveira AA, Mestre A, Santos C. Vasculitis of small and large vessels, a casual association? ACTA ACUST UNITED AC 2018; 64:590-594. [PMID: 30365660 DOI: 10.1590/1806-9282.64.07.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 12/05/2017] [Indexed: 11/22/2022]
Abstract
The authors report a case of a 69-year-old man with idiopathic leukocytoclastic cutaneous vasculitis. For three years, the lesions recurred with progressive worsening and were associated with systemic manifestations of low-grade fever, weight loss and raised inflammatory markers. The patient latter presented a 6th cranial nerve involvement, raising the concern of a possible systemic vasculitis, which was latter evidenced by the development of deep vein thrombosis and angina pectoris. The treatment of the patient witch based on the decreasing of inflammatory activity, by using effective immunosuppressive therapy, with lower toxicity is more important than identifying the type of the vasculitis. This case illustrates the importance of awareness for the systemic involvement that can occur in up to 50% of patients with leukocytoclastic cutaneous vasculitis.
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Affiliation(s)
- Filipa Pedro
- Internal Medicine Department - III, District Hospital of Santarem, Portugal
| | - Yahia Abuowda
- Internal Medicine Department - III, District Hospital of Santarem, Portugal
| | - Nuno Craveiro
- Internal Medicine Department - III, District Hospital of Santarem, Portugal
| | - Ana Alves Oliveira
- Internal Medicine Department - III, District Hospital of Santarem, Portugal
| | - Ana Mestre
- Internal Medicine Department - III, District Hospital of Santarem, Portugal
| | - Cristina Santos
- Internal Medicine Department - III, District Hospital of Santarem, Portugal
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5
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Mohamed R. Response to comment on: Diagnostic positron emission tomography-computed tomography in clinically elusive giant cell arteritis. Indian J Ophthalmol 2018; 66:1656-1657. [PMID: 30355898 PMCID: PMC6213676 DOI: 10.4103/ijo.ijo_1469_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ryian Mohamed
- Department of Ophthalmology, Abergele Hospital, Abergele, LL22 8DP, UK
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Gál R, Bălaşa R, Bajkó Z, Maier S, Simu I, Bălaşa A. Lethal Subarachnoid and Intracerebral Haemorrhage Associated with Temporal Arteritis. A Case Report. ACTA ACUST UNITED AC 2017; 3:153-157. [PMID: 29967889 PMCID: PMC5769904 DOI: 10.1515/jccm-2017-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/13/2017] [Indexed: 11/15/2022]
Abstract
Giant cell arteritis is a systemic inflammatory vasculitis, typically involving the superficial temporal arteries, but with possible ischemic and hemorrhagic cerebrovascular complications. The case is reported of a patient with a clinical picture of giant cell arteritis, who had multiple occupational exposures to various infectious agents. His initial favourable progress was followed by an atypical outcome. Despite immunosuppressive treatment, he developed fatal subarachnoid and intracerebral haemorrhages, possibly due to rupture of a microaneurysm of the posterior cerebral artery.
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Affiliation(s)
- Réka Gál
- Mureş County Clinical Emergency Hospital Târgu Mureş, Neurology Clinic II,Târgu Mureş, România
| | - Rodica Bălaşa
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, România
| | - Zoltán Bajkó
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, România
| | - Smaranda Maier
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, România
| | - Iunius Simu
- University of Medicine and Pharmacy Târgu Mureş, Department of Radiology, Târgu Mureş, România
- Iunius Simu, University of Medicine and Pharmacy Târgu Mureş, Department of Radiology, Gheorghe Marinescu street 38, 540139, Târgu Mureş, România.
| | - Adrian Bălaşa
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurosurgery, Târgu Mureş, România
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Hur JH, Chun EJ, Kwag HJ, Yoo JY, Kim HY, Kim JJ, Lee KW. CT Features of Vasculitides Based on the 2012 International Chapel Hill Consensus Conference Revised Classification. Korean J Radiol 2017; 18:786-798. [PMID: 28860896 PMCID: PMC5552462 DOI: 10.3348/kjr.2017.18.5.786] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/14/2017] [Indexed: 12/26/2022] Open
Abstract
Vasculitis, characterized by inflammation of vessel walls, is comprised of heterogeneous clinicopathological entities, and thus poses a diagnostic challenge. The most widely used approach for classifying vasculitides is based on the International Chapel Hill Consensus Conference (CHCC) nomenclature system. Based on the recently revised CHCC 2012, we propose computed tomography (CT) features of vasculitides and a differential diagnosis based on location and morphological characteristics. Finally, vasculitis mimics should be differentiated, because erroneous application of immunosuppressive drugs on vasculitis mimics may be ineffective, even deteriorating. This article presents the utility of CT in the diagnosis and differential diagnosis of vasculitides.
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Affiliation(s)
- Jee Hye Hur
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Hyon Joo Kwag
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Jin Young Yoo
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Hae Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jeong Jae Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Calvo Romero J. Giant cell arteritis: Diagnosis and treatment. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Calvo Romero JM. Giant cell arteritis: diagnosis and treatment. Rev Clin Esp 2015; 215:331-7. [PMID: 25957859 DOI: 10.1016/j.rce.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/27/2015] [Accepted: 03/09/2015] [Indexed: 11/16/2022]
Abstract
Giant cell arteritis is the most common primary systemic vasculitis in adults. The condition is granulomatous arteritis of large and medium vessels, which occurs almost exclusively in patients aged 50 years or more. This article reviews the diagnosis and treatment of the disease.
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Affiliation(s)
- J M Calvo Romero
- Servicio de Medicina Interna, Hospital Ciudad de Coria, Coria, Cáceres, España.
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Rooney PJ, Rooney J, Balint G, Balint P. Polymyalgia rheumatica: 125 years of epidemiological progress? Scott Med J 2014; 60:50-7. [PMID: 25201886 DOI: 10.1177/0036933014551115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES On the 125th anniversary of the first recognised publication on polymyalgia rheumatica, a review of the literature was undertaken to assess what progress has been made from the point of view of the epidemiology of this disease and whether such studies have advanced our knowledge of its aetiopathogenesis and management. METHODS The authors searched Medline and PubMed using the search terms 'polymyalgia rheumatica', 'giant cell arteritis' and 'temporal arteritis'. As much as possible, efforts were made to focus on studies where polymyalgia and giant cell arteritis were treated as separate entities. The selection of articles was influenced by the authors' bias that polymyalgia rheumatica is a separate clinical condition from giant cell arteritis and that, as yet, the diagnosis is a clinical one. RESULTS This review has shown that, following the recognition of polymyalgia as a distinct clinical problem of the elderly, the results of a considerable amount of research efforts investigating the populations susceptible, the geographic distribution of these affected populations and the associated sociological and genetic elements that might contribute to its occurrence, polymyalgia rheumatica remains a difficult problem for the public health services of the developed world. CONCLUSIONS Polymyalgia rheumatica remains a clinical enigma and its relationship to giant cell arteritis is no clearer now than it has been for the past 125 years. Diagnosing this disease is still almost exclusively dependent on the clinical acumen of a patient's medical attendant. Until an objective method of identifying it clearly in the clinical setting is available, uncovering the aetiology is still unlikely. Until then, clear guidelines on the future incidence and prevalence of polymyalgia rheumatica and the public health problems of the disease and its management, especially in relation to the use of long term corticosteroids, will be difficult to provide.
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Affiliation(s)
- Patrick J Rooney
- Professor of Medicine, Department of Clinical Skills, St George's University, Grenada
| | - Jennifer Rooney
- Associate Professor of Medicine, Department of Clinical Skills, St George's University, Grenada
| | - Geza Balint
- Consultant Rheumatologist, National Institute of Rheumatology and Physiotherapy, Hungary
| | - Peter Balint
- Head of Department and Consultant Rheumatologist, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Hungary
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Reddi S, Vollbracht S. Giant Cell Arteritis Associated With Orbital Pseudotumor. Headache 2013; 53:1488-9. [DOI: 10.1111/head.12100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sudama Reddi
- Department Neurology; Albert Einstein College of Medicine; Montefiore Medical Center; Bronx; NY; USA
| | - Sarah Vollbracht
- Department Neurology; Albert Einstein College of Medicine; Montefiore Medical Center; Bronx; NY; USA
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Mathew T, Aroor S, Devasia AJ, Mahadevan A, Shobha V, Nadig R, Varghese R, Shankar SK, Sarma GRK. Temporal arteritis: A case series from south India and an update of the Indian scenario. Ann Indian Acad Neurol 2012; 15:27-30. [PMID: 22412269 PMCID: PMC3299067 DOI: 10.4103/0972-2327.93272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 12/10/2011] [Accepted: 12/17/2011] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study the clinical, pathological and prognostic profile of patients with temporal arteritis in India. MATERIALS AND METHODS The study was conducted in a tertiary care center from south India from 2005 to 2010 in the departments of neurology and medicine. The details of all patients that satisfied the ACR 1990 criteria for diagnosis of temporal arteritis were reviewed. The clinical presentation, laboratory parameters and biopsy findings of the patients were analyzed and compared with other studies from India done over the last decade. RESULTS A total of 15 patients were diagnosed with temporal arteritis. The male:female ratio was 1.5:1. The mean age of onset was 67.58 years. Mean time for detection after onset of symptoms was 2.56 months. Typical manifestations included headache (100%), temporal artery tenderness (100%), jaw claudication (20%), polymyalgia rheumatica (53%) and visual manifestations (20%). The erythrocyte sedimentation rate was elevated in all patients. Biopsy was done in 13 patients, with 11 of them being positive. All patients responded to steroids well, with most patients being symptom-free within the first 48 h of treatment. CONCLUSIONS Temporal arteritis seems to be underdiagnosed in India, with all patients previously misdiagnosed, and with a mean time from symptom onset to diagnosis of 2.5 months. The clinical presentation of temporal arteritis in India appears to be similar to that of the West, with no gender preference and a slightly younger age group.
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Affiliation(s)
- Thomas Mathew
- Department of Neurology, St. John's Medical College, Bangalore, Karnataka, India
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Carolei A, Sacco S. Headache attributed to arteritis, cerebral venous thrombosis, and other vascular intracranial disturbances. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:529-540. [PMID: 20816454 DOI: 10.1016/s0072-9752(10)97048-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Headache with variable characteristics and associated signs and symptoms may occur in all forms of arteritis. Giant cell arteritis, one of the most common forms, involves branches of the external and, more rarely, of the internal carotid arteries. It occurs in patients over the age of 50 and is characterized by fever, new-onset headache, prominence and tenderness of the temporal artery, claudication of the masticatory muscles on chewing, amaurosis fugax, and visual loss. Headache is the initial symptom in 48% of patients and is present in 90%. Primary central nervous system angiitis is a rare and highly fatal disease in which headache is one of the most frequent symptoms despite the fact that, given its non-specific characteristics, it is of little diagnostic relevance. Headache may also be attributed to several secondary central nervous system arteritides such as Behçet's disease, Takayasu disease, polyarteritis nodosa, Kawasaki disease, Wegener's granulomatosis, systemic lupus erythematosus, and vasculitits caused by viruses, bacteria, fungi, rickettsiae, and protozoa. Thrombosis of the cerebral veins and sinuses is a distinct cerebrovascular disorder that, unlike arterial stroke, most often affects young adults and children. Headache is the most frequent but least specific symptom of venous sinus thrombosis, being present in more than 90% of patients. Headache can also be attributed to other vascular intracranial disorders such as cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), benign (or reversible) angiopathy of the central nervous system, and pituitary apoplexy.
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Affiliation(s)
- Antonio Carolei
- Department of Neurology, University of L'Aquila, L'Aquila, Italy.
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Ciappetta P, D'Urso PI, Colamaria A, Lauta E, Cimmino A, D'Urso OF, Rossi R, Resta L, Ingravallo G. Giant cell angiitis of the central nervous system with atypical presentation. Neuropathology 2009; 30:434-8. [PMID: 19925563 DOI: 10.1111/j.1440-1789.2009.01073.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Giant cell angiitis of the CNS is an uncommon form of vasculitis. Neurological manifestations, both of the peripheral and CNS, are common. The most frequent manifestations are visual loss and stroke. Hemorrhagic onset is uncommon. Most cases have a fatal outcome and a tissue diagnosis is rarely established in life. We describe an unusual case of giant cell angiitis beginning as a hemorrhagic tumoral-like lesion. The results of the histological and ultrastructural analysis have also been reported. Our case illustrates that giant cell angiitis should be considered as a cause of intracerebral hemorrhage, particularly when associated with a relapsing and remitting disease of the CNS.
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Affiliation(s)
- Pasqualino Ciappetta
- Department of Neurological and Psychiatric Sciences, University of Bari Medical Schoo, Bari, Italy
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Khalifa M, Karmani M, Jaafoura NG, Kaabia N, Letaief AO, Bahri F. Epidemiological and clinical features of giant cell arteritis in Tunisia. Eur J Intern Med 2009; 20:208-12. [PMID: 19327614 DOI: 10.1016/j.ejim.2008.07.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Revised: 06/20/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Giant cell arteritis (GCA) is a systemic vasculitis of the elderly that could result in vision loss or even be life threatening. Unlike western countries, this disease is considered exceptional in Tunisia. OBJECTIVE The aims of this study were to determine epidemiological and clinical features of GCA in Tunisian population and to identify management difficulties. PATIENTS AND METHODS A multicentric study of 96 patients in whom GCA was diagnosed between 1986 and 2003. All patients fulfilled the ACR criteria for classification of GCA. RESULTS The majority of cases (77%) were diagnosed since 1994. The male/female ratio was 0.88 and the mean age at the time of diagnosis was 70.8+/-7.7 years. Clinical features were characterized by gradual onset in 64.4% of cases. The most frequent clinical manifestations were headache (91.7%), abnormalities in temporal arteries (85.4%), severe ischemic manifestations (80.2%), constitutional symptoms (75%), and polymyalgia rheumatica (56.3%). Biological inflammatory syndrome was noted in all patients. Temporal artery biopsy established histological diagnosis in 73% of cases. All patients were treated by corticosteroids. Remission was obtained in 45.6%. Relapses occurred in 40.4% of cases and 30 patients were still receiving corticosteroids at the time of study. Four patients died and irreversible ischemic complications were noted in 15.6% of cases. Steroid adverse effects occurred in 56 patients. CONCLUSION GCA is not exceptional to Tunisia. It occurs amongst elderly patients with no female predominance noticed. Clinical features are similar to those reported in other series.
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Affiliation(s)
- Mabrouk Khalifa
- Department of Internal Medicine, University hospital Farhat Hached-Sousse, Tunisia.
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Atluri P, Woo YJ. High-risk repair of ascending aortic aneurysm due to giant cell aortitis. Asian Cardiovasc Thorac Ann 2007; 15:252-4. [PMID: 17541000 DOI: 10.1177/021849230701500318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Giant cell arteritis increases the risk of developing a thoracic aortic aneurysm. Thoracic aortic aneurysm repair in octogenarians carries a profound increase in postoperative morbidity and mortality. We report the successful repair of an ascending aortic aneurysm in an 83-year-old woman with a history of treatment for temporal arteritis and pathologic evidence of giant cell aortitis.
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Affiliation(s)
- Pavan Atluri
- Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Silverstein 4, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Kwon CM, Hong YH, Chun KA, Cho IH, Kim MJ, Shin DG, Hyun MS, Kim YJ. A case of silent giant cell arteritis involving the entire aorta, carotid artery and brachial artery screened by integrated PET/CT. Clin Rheumatol 2007; 26:1959-62. [PMID: 17340046 DOI: 10.1007/s10067-007-0592-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 02/09/2007] [Accepted: 02/09/2007] [Indexed: 10/23/2022]
Abstract
We report a case of giant cell arteritis involving the aorta and several large arteries identified by integrated positron emission tomography (PET)/computed tomography (CT) obtained in a patient with a high erythrocyte sedimentation rate (ESR). A 63-year-old man with anemia and a high ESR noted on a regular medical examination was transferred to our department. The patient complained of only a low-grade general weakness for several months; there were no specific symptoms or signs. A PET was recommended. The image showed strong (18)F-fluorodeoxyglucose ((18)F-FDG) uptake at the ascending aorta, aortic arch, descending aorta, thoraco-lumbar aorta, brachial artery, and the carotid artery wall, bilaterally. Suspicious for large-vessel vasculitis, a temporal artery biopsy was performed, which confirmed giant cell arteritis. After treatment with prednisolone, the high ESR and anemia resolved, and (18)F-FDG uptake decreased on follow-up integrated PET/CT.
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Affiliation(s)
- Chang Mo Kwon
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
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Abstract
Giant cell arteritis predominantly affects cranial arteries and rarely involves other sites. We report a patient who presented with small bowel obstruction because of infarction from mesenteric giant cell arteritis. She had an unusual cause of her obstruction and a rare manifestation of giant cell arteritis. In spite of aggressive therapy with steroids, she died a month later because of multiple complications. We discuss the diagnosis and management of small bowel obstruction and differential diagnosis of vasculitis of the gastrointestinal tract. We were able to find 11 cases of bowel involvement with giant cell arteritis in the English literature. This case report illustrates that giant cell arteritis can be a cause of small bowel obstruction and bowel infarction. In the proper clinical setting, vasculitides need to be considered early in the differential diagnosis when therapy may be most effective.
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Affiliation(s)
- Aniyizhai Annamalai
- Department of General Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL 62794-9636, USA.
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Abstract
Vasculitis presents several diagnostic challenges. Firstly, patients could present with protean clinical manifestations with a wide spectrum ranging from isolated cutaneous vasculitis to multisystem involvement. Secondly, there are several medical conditions that could mimic the presentation of vasculitis. The range of differential diagnosis is therefore broad. Thirdly, vasculitis could occur as a primary disorder or be secondary to various medical conditions. It becomes important to differentiate them, as treatment of some forms of vasculitis such as those that are secondary to infection or drugs, is different from that of primary vasculitis. Fourthly, there are several different forms of vasculitis. Some are benign and self limiting, while others have the potential to threaten vital organ function and life. It follows that a rational approach is required during evaluation of patients with suspected vasculitis.
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Affiliation(s)
- E Suresh
- Rheumatology Department, Kettering General Hospital, Rothwell Road, Kettering NN16 8UZ, UK.
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Howaizi M, Kanate A. Sclerosing mesenteritis associated with giant-cell temporal arteritis. Eur J Intern Med 2006; 17:511-3. [PMID: 17098599 DOI: 10.1016/j.ejim.2006.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Revised: 04/03/2006] [Accepted: 04/11/2006] [Indexed: 11/27/2022]
Abstract
A 72-year-old man presented with a history of progressive abdominal pain associated with simultaneous headache, constitutional syndrome, and weight loss. A CT scan demonstrated sclerosing mesenteritis (SM). A surgical biopsy of mesenteric tissue excluded malignancies and a temporal artery biopsy showed giant-cell arteritis, establishing the diagnosis of SM associated with giant-cell temporal arteritis (GCA). Both entities responded well to steroid therapy and relapsed simultaneously after steroid withdrawal. This association may be fortuitous, but it can also represent a unique clinical setting. We suggest ruling out GCA every time a SM is encountered in the appropriate clinical setting (i.e., in elderly patients with other symptoms and signs suggestive of GCA). A temporal artery biopsy may be systematically considered in these patients.
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Affiliation(s)
- Mehran Howaizi
- Service de Gastroentérologie et hépatologie, Fédération médicochirurgicale des maladies de l'appareil digestif, Hôpital Simone Veil, 95602 Eaubonne, France
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Zachariades N, Skoura C, Spanou A, Machera H. Temporal arteritis: report of a case. ACTA ACUST UNITED AC 2006; 102:192-7. [PMID: 16876061 DOI: 10.1016/j.tripleo.2005.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Revised: 05/03/2005] [Accepted: 06/13/2005] [Indexed: 11/18/2022]
Abstract
Temporal arteritis is a rheumatic disease that affects large and medium-sized arteries. It is a severe arteritis involving both the intima and media of the vessel and is a cause of headache that is frequently diagnosed erroneously as "atypical migraine." The patients have a burning or throbbing type of pain. Ultimately, there is localized inflammation or cellulitis over the swollen, tortuous artery. Jaw claudication, eye pain, photophobia, diplopia, and even blindness may accompany the temporal symptoms. As many as 20% to 60% of inadequately treated or untreated patients will lose their vision. Blindness may or may not be preceded by visual symptoms and funduscopic changes. A variety of systemic symptoms are also often present, including nausea, vomiting, chills, dizziness, and loss of weight. Temporal arteritis is not a common diagnosis in maxillofacial practice. We are presenting a case of temporal arteritis diagnosed after a biopsy. The patient eventually lost the vision from one eye.
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Affiliation(s)
- Nicholas Zachariades
- Oral and Maxillofacial Department, KAT General District Hospital, Kifissia, Athens, Greece.
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Affiliation(s)
- Raimund Erbel
- Department of Cardiology, University Duisburg-Essen, Germany.
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Eljarrat-Binstock E, Raiskup F, Frucht-Pery J, Domb AJ. Transcorneal and transscleral iontophoresis of dexamethasone phosphate using drug loaded hydrogel. J Control Release 2005; 106:386-90. [PMID: 16026884 DOI: 10.1016/j.jconrel.2005.05.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Revised: 05/17/2005] [Accepted: 05/19/2005] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate dexamethasone penetration to the eye after a short transcorneal and transscleral iontophoresis using a drug loaded hydrogel assembled on a portable iontophoretic device. METHODS Iontophoresis of dexamethasone phosphate was studied in healthy rabbits using drug loaded disposable HEMA hydrogel sponges and portable iontophoretic device. Corneal iontophoretic administration was performed with a current intensity of 1 mA for 1 and 4 min. Transconjunctival and transscleral iontophoresis were performed twice for 2 min at two near places in the pars-plana area, on the conjunctival membrane or directly on the sclera. Dexamethasone concentrations were assayed using HPLC. RESULTS Dexamethasone levels in the rabbit cornea after a single transcorneal iontophoresis for 1 min were up to 30 fold higher compared to those obtained after frequent eye drop instillation. Also, high drug concentrations were obtained in the retina and sclera 4 h after transscleral iontophoresis. CONCLUSIONS A short low current non-invasive iontophoretic treatment using dexamethasone-loaded hydrogels has potential clinical value in increasing drug penetration to the anterior and posterior segments of the eye.
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Affiliation(s)
- Esther Eljarrat-Binstock
- Department of Medicinal Chemistry and Natural Products, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
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Bahra A. Headache. Br J Hosp Med (Lond) 2005; 66:M45-7. [PMID: 16255259 DOI: 10.12968/hmed.2005.66.sup3.19907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Headache can be divided into primary headache and secondary headache. In primary headache the headache syndrome, i.e. the head pain and any associated features, are the disease process. In secondary headache the headache syndrome is a symptom of an underlying disorder. The secondary headache may have the same clinical features as a primary headache disorder.
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Affiliation(s)
- Anish Bahra
- The Headache Group, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG
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Gelsomino S, Romagnoli S, Gori F, Nesi G, Anichini C, Sorbara C, Stefàno P, Gensini GF. Annuloaortic Ectasia and Giant Cell Arteritis. Ann Thorac Surg 2005; 80:101-5. [PMID: 15975349 DOI: 10.1016/j.athoracsur.2005.01.063] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2004] [Revised: 01/05/2005] [Accepted: 01/07/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thoracic aortic aneurysm, aortic dissection and aortic valve regurgitation have been widely described in patients with Horton disease, also known as giant cell arteritis. We present our midterm experience with patients with these features. METHODS A total of 386 cases of ascending aorta and aortic valve replacement performed for thoracic aortic aneurysm and aortic insufficiency between 1998 and 2004 were reviewed. Among them 10 cases of histopathologically confirmed GAA were identified. Patients were predominantly female (90%); the mean age was 74.5 +/- 4.6 years. RESULTS Eight patients (80%) showed typical annuloaortic ectasia, leading to significant aortic valve regurgitation. These subjects underwent a Bentall operation. Two patients whose sinuses seemed undilated and macroscopically normal had separate valve graft replacement at first operation and underwent reoperation due to dilatation of the native sinuses. Eight patients had partial aortic arch replacement (hemiarch), and 1 underwent total arch replacement. Six-year survival was 0.9 +/- 0.09; freedom from reoperation at 6 years was 0.77 +/- 0.13. CONCLUSIONS Annuloaortic ectasia is a common finding in giant cell arteritis. In patients with Horton disease, the aortic root should always be replaced regardless of macroscopic findings.
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Affiliation(s)
- Sandro Gelsomino
- Department of Cardiac Surgery, Careggi Hospital, Florence, Italy.
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