Giant cell arteriitis

Kyle, V., Wraight, E.R, Hazleman, B.L. Liver scan abnormaUties in polymyalgia rheumatica/giant-cell arteriitis. Clin. Rheumatol. 1991 10 294-297... 

Leong, A.S., Alp, M.H. Hepatocellular disease in the giant cell arteri-itis/polymyalgia rheumatica syndrome. Ann. Rheum. Dis. 1981 40 ... 

Q77 Giant cell arteritis may present with tender and non-pulsatile temporal arteries together with erythema and oedema of the overlying skin. The condition may require the use of prednisolone tablets for at least 2 years. 

Giant cell arteritis (cranial or temporal arteritis) is an inflammatory condition that may affect any of the large arteries, especially the temporal and occipital arteries. The thickened temporal arteries may be tender and non-pulsatile, with erythema and oedema of the overlying skin. Early treatment with high-dose corticosteroids such as prednisolone is essential and should be continued for a minimum of 2-3 years at a reduced dose. 

A 64-year-old man with giant cell arteritis was given prednisolone 60 mg/day. Within 5 days he developed double vision and agitation and became drowsy and confused. A cranial MRI scan showed recent cerebral lesions and a Doppler scan showed high-resistant blood flow in both vertebral arteries. He had an episode of complete loss of vision and was given dexamethasone... 

Giant cell arteritis is the most common vascuUtic cause of stroke and is associated particularly with posterior circulation ischemia (Nesher 2000 Ronthal et al. 2003 Eberhardt and Dhadly 2007). Medium and large arteries are affected, especially branches of the external carotid artery, the ophthalmic artery and the vertebral artery. The patients are elderly, with the diagnosis being rare under age 60 years. Malaise, polymyalgia and other systemic symptoms are frequently present. The erythrocyte sedimentation rate is usually raised, often to over 100 mm/h in the first hour. 

Headache is not uncommon around the time of stroke onset. It is more often severe in primary intracerebral hemorrhage than ischemic stroke, and more often severe with posterior than anterior circulation strokes. If the headache is localized at all, it tends to be over the site of the lesion. Headache is more common in cortical and posterior circulation than lacunar infarcts (Kumral et al. 1995). Severe unilateral neck, orbital or scalp pain suggests internal carotid artery dissection, particularly if there is an ipsilateral Horner s syndrome. Severe occipital headache can occur with vertebral artery dissection. Headache is also a particular feature of venous infarcts. Unusual headache in the days before stroke would suggest giant cell arteritis or perhaps a mass lesion rather than a stroke. 

Stroke in the context of preceeding malaise for up to some months suggests an inflammatory arterial disorder, particularly giant cell arteritis, infective endocarditis, cardiac myxoma, cancer, thrombotic thrombocytopenic purpura or even sarcoidosis (Ch. 6). 

Tenderness of the branches of the external carotid artery (occipital, facial, superficial temporal) points towards giant cell arteritis. Tenderness of the common carotid artery in the neck can occur in acute carotid occlusion but is more Ukely to be a sign of dissection, or arteritis. Absence of several neck and arm pulses in a young person occurs in Takayasu s arteritis (Ch. 6). Delayed or absent leg pulses suggest coarctation of the aorta or, much more commonly, peripheral vascular disease. Other causes of widespread disease of the aortic arch are atheroma, giant cell arteritis, syphihs, subintimal fibrosis, arterial dissection and trauma. 

Causes of occlusion are as follows (I.) primary vascular diseases (nodular periarteritis, giant-cell arteritis, etc.), (2.) iatrogenic measures (intra-arterial catheterization,... 

Urinary tract A 49-year-old man with HTV took indinavir 800 mg tds for 8 years and developed nephrolithiasis, crystal-induced tubular injury with rupture, acute tubular necrosis, and arterial and arteriolar nephrosclerosis electron microscopy showed a granulomatous giant cell reaction and intraluminal indinavir crystals [121 ]. 

In 2001, about 2,900 new cases of cancer of the bones and joints were diagnosed, and about 1,400 deaths from these cancers were expected. Primary cancers of bones account for less than 0.2% of all cancers. Regional management options consisting of intraarterial chemotherapy and arterial embolization have been used with favorable results in the treatment of osteosarcoma, unre-sectable giant cell tumors, and aneurysmal bone cysts. 

Chuang VP et al. (1981a) Arterial occlusion management of giant cell tumor and aneurysmal bone cyst. AJR Am J Roentgenol 136 1127-1130... 

Scattered throughout the interstitium are poorly formed granulomas consisting of small clusters of epithelioid histiocytes and occasional giant cells. The granulomas tend to be near airways or arteries. If the granulomas are well formed or contain necrosis other diseases should be considered such as sarcoidosis or infection. The giant cells may contain small stellate-shaped asteroid bodies or calcified Schaumann bodies. 

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