Scherle MCE, Miranda HJL, Fernández CL, Rivero RD, Pérez CD

Language: Spanish
References: 14
Page: 25-28
PDF size: 304.65 Kb.

ABSTRACT

Introduction: Giant-cell arteritis or temporal arteritis is the most common form of systemic vasculitis in adults. The diagnosis is based on clinical grounds and temporal artery biopsy. Prompt diagnosis and steroids treatment are important to prevent vascular complications. Color Duplex ultrasonography represents a non-invasive method to diagnose temporal arteritis.
Clinical case: Female patient, 73 years old with history of bilateral headache with one month evolution, jaw claudication myalgia and diplopia. Neurological examination showed tenderness to palpation and decreased pulsation in temporal arteries (mainly in left artery), left abducens paralysis, stiffness and neck pain. Color duplex ultrasound of the temporal artery showed dark circumferential wall thickening of both temporal arteries (halo sign). This patient was treated with prednisone (60 mg/diary with gradual reduction to maintenance with 20 mg/diary) and aspirin (125 mg/diary). Progressively was disappeared clinical manifestations and inflammatory halo in both temporal arteries detected with color duplex ultrasound.
Conclusions: Color duplex ultrasonography is one current alternative to temporal artery biopsy for temporal arteritis diagnosis. This technique is helpful for assessment of temporal arteritis evolution and steroid treatment response.

REFERENCES

1. Nesher G. The diagnosis and classification of giant cell arteritis. J Autoimmun. 2014;48-49:73-5.

2. García-García J, Ayo-Martín Ó, Argandoña-Palacios L, Segura T. Vertebral Artery Halo Sign in Patients with Stroke: A Key Clue for the Prompt Diagnosis of Giant Cell Arteritis. Stroke. 2011;42(11):1-4.

3. Ikard RW. Clinical efficacy of temporal artery biopsy in Nashville, Tennessee. South Med J. 1988;81(10):1222-4.

4. Bhatti MT, Goldstein MH. Facial nerve injury following superficial temporal artery biopsy. Dermatol Surg. 2001;27(1):15-7.

5. Siemssen SJ. On the occurrence of necrotizing lesions in arteritis temporalis: review of the literature with a note on the potential risk of a biopsy. Br J Plast Surg. 1987;40(1):73-82.

6. Haist SA. Stroke after temporal artery biopsy [Letter]. Mayo Clin Proc. 1985;60(8):538.

7. Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990;33(8):1122-8.

8. Schmidt WA. Ultrasound in vasculitis. Clin Exp Rheumatol. 2014;32(1 Suppl 80):S71-7.

9. Diamantopoulos AP, Haugeberg G, Hetland H, Soldal DM, Bie R, Myklebust G. Diagnostic value of color Doppler ultrasonography of temporal arteries and large vessels in giant cell arteritis: a consecutive case series. Arthritis Care Res (Hoboken). 2014;66(1):113-9.

10. Barrier J, Potel G, Renaut-Hovasse H, Hanh TH, Peltier P, Chamary V, et al. The use of Doppler flow studies in the diagnosis of giant cell arteritis. JAMA. 1982;248(17):2158–9.

11. Schmidt WA. Role of ultrasound in the understanding and management of vasculitis. Ther Adv Musculoskelet Dis. 2014;6(2):39-47.

12. Ball EL, Walsh SR, Tang TY, Gohil R, Clarke, JM. Role of ultrasonography in the diagnosis of temporal arteritis. Br J Surg. 2010;97(12):1765–71.

13. Karassa FB, Matsagas MI, Schmidt WA, Loannidis JP. Meta-analysis: test performance of ultrasonography for giant-cell arteritis. Ann Intern Med. 2005;142(5):359–69.

14. Arida A, Kyprianou M, Kanakis M, Sfikakis P. The diagnostic value of ultrasonography derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis. BMC Musculoskelet Disord. 2010;11:44.