Giant cell arteritis

Case contributed by Dr. Mandakini Siwach


Clinical suspicion of temporal arteritis

Patient Data

Age: 50 years
Gender: Female

The left temporal artery and its frontal and parietal branches shows significant wall thickening. Prominent mural enhancement is identified in these arteries, when compared to the contralateral side. The contralateral temporal artery and its branches shows a normal appearance.

Annotated image

Arrows indicate the position of the abnormal left temporal arteries. 

Case Discussion

Temporal arteritis or giant cell arteritis (GCA) is a chronic granulomatous vasculitis involving medium to large sized arteries, predominantly involving the cranial branches of the arteries originating from the arch of aorta. The incidence of GCA peaks between the ages of 70-80 years, rarely before 50 years.

New onset headache is a frequent complaint. Visual symptoms may occur, with visual loss as a dreaded complication.

Certainty regarding diagnosis is needed, considering the side effects of long-term steroids required for treatment. Temporal artery biopsy is the gold standard for diagnosis, though high-resolution MRI imaging of the superficial temporal artery is promising non-invasive means of assessing the mural thickening and inflammation. MRI imaging should be performed before or just after starting corticosteroid treatment.

Bley et al used the following four point ranking scale for scoring mural inflammation:

  • 0: no mural thickening (0.5 mm) and no mural enhancement
  • 1: no mural thickening (0.5 mm) with only slight contrast enhancement
  • 2: mural thickening (0.6mm) and prominent mural enhancement
  • 3: strong mural thickening (0.7 mm) and strong mural enhancement

Scores of 0 and 1 were considered as physiologically normal, whereas 2 and 3 were considered as signs of mural inflammation.

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