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PubMed1976

Immunological and histological studies of temporal arteries from patients with temporal arteritis and/or polymyalgia rheumatica.

Biopsies from the temporal arteries of 62 out of 80 patients presenting the clinical picture of temporal arteritis and/or polymyalgia rheumatica showed morphologically active or healed arteritis. Fifty-five of these biopsies revealed anti-IgG activity as measured by the mixed agglutination test. In 21 of the 27 cases which could be completely studied, the anti-IgG activity was connected with the presence of IgA, either alone, or together with IgG or IgM, or both, and complement. All of these 21 biopsies showed morphologically active granulomatous arteritis with signs of tissue destruction. In 6 biopsies, the active component appeared to be some type of Fc receptor in the tissue. Morphologically these biopsies showed either non-granulomatous mononuclear arteritis without definite necrosis or they represented various stages of healing arteritis with no or minor signs of tissue destruction. Weak anti-IgG activity was often found in a morphological type characterized by minimal inflammatory activity. These lesions are easily overlooked and the mixed agglutination test proved to be a good diagnostic tool in such cases. Arteries without anti-IgG activity showed no signs of active arteritis.

Antibodies, Anti-Idiotypic↗
PubMed1996

[Color Doppler ultrasound of the temporal arteries--a new method for diagnosing temporal arteritis].

BACKGROUND: Recently increasing attention has been paid to temporal arteritis which is not a very rare disease. Early establishment of the diagnosis and start of therapy can reduce serious visual complications. PATIENTS AND METHODS: The temporal arteries of 10 patients with temporal arteritis, 8 patients with polymyalgia rheumatica, and 23 controls were investigated with a high resolution ultrasound system, measuring size of lumen and wall as well as blood flow velocity. RESULTS: Colour doppler sonography of the superficial temporal artery showed a characteristic hypoechoic halo around the perfused lumen of an often stenosed or occluded artery. Neither patients with polymyalgia rheumatica nor controls had this hypoechoic halo. The halo disappeared 10-14 days after start of therapy with glucocorticoids. CONCLUSIONS: We think that colour doppler sonography of the temporal arteries is a simple, quick, and non-invasive method to diagnose temporal arteritis. When there will be more experience, sensitivity and specificity of the method can be defined. Perhaps sonography might replace biopsy in some cases in the future.

Aged↗
PubMed2005

[Ultrasonography of temporal arteries in suspected temporal arteritis].

BACKGROUND: In order to avoid complications in temporal arteritis, early diagnosis and start of treatment is essential. In many cases, however, the symptoms and clinical signs are non-specific. Surgical biopsy has disadvantages, and false-negative results occur. MATERIAL AND METHODS: The use of colour Doppler sonography in the diagnosis of temporal arteritis is described, based on a PubMed search and our clinical experience. Two case histories are included. RESULTS AND INTERPRETATION: In recent literature, colour Doppler sonography is described as a new, non-invasive diagnostic tool for temporal arteritis with reported high diagnostic accuracy. The periluminal halo is assumed to represent infiltration and oedema in the arterial wall. Sonography may become a valuable contribution in the diagnostic work-up of patients with non-specific symptoms, and in others patients for guiding the surgical biopsy to an optimal site. It might also be possible to avoid surgical biopsy in selected patients with typical sonographic findings.

Aged↗
PubMedDate not supplied

[Color duplex ultrasound of the temporal artery: replacement for biopsy in temporal arteritis].

The diagnosis of temporal arteritis (TA) is generally confirmed by biopsy. To investigate the diagnostic accuracy of color duplex sonography (CDS), both temporal arteries of 20 patients with suspected TA were prospectively insonated prior to biopsy. Detection of >or=1 hypoechogenic perivascular halo was used as CDS criterion, a temporal artery biopsy and the criteria of the American College of Rheumatology (ACR) as references. The frequency of halo disappearance after 3 months of steroid therapy was also studied. CDS showed TA in 6, biopsy in 12 and ACR criteria in 15 patients. CDS sensitivity was 50 and 40%, and specificity 100%, using the biopsy and the ACR criteria, respectively. After 3 months of steroid treatment, 1 patient still showed halos. In conclusion, detection of halos confirms, whereas the absence of halos does not exclude the diagnosis of TA suggesting that ultrasound may replace biopsy in single patients with typical clinical signs and symptoms and a halo.

Aged↗
PubMed1989

Contralateral hemiplegia in herpes zoster ophthalmicus. Role of temporal artery biopsy.

We describe clinical, radiological and pathological findings in a case of herpes zoster ophthalmicus who developed contralateral hemiplegia. The CT scan showed discrete infarction of the right internal capsule and the right carotid angiogram showed concentric narrowing of the supraclinoid portion of right internal carotid artery. Superficial temporal artery biopsy showed infiltration by lymphocytes and plasma cells without any granuloma formation or giant cells. The importance of trigemino-vascular connections in the pathogenesis of this complication of herpes zoster ophthalmicus and the role of temporal artery biopsy in the diagnosis of arteritis following herpes zoster are discussed.

Biopsy↗
PubMed1995

Non-giant cell arteritis of the temporal artery presenting as the polymyalgia rheumatica-temporal arteritis syndrome.

We describe a heterogeneous group of 4 elderly patients with atypical vasculitis of the temporal artery who presented clinically with the polymyalgia rheumatica-temporal arteritis syndrome. The first had apparently isolated eosinophilic necrotizing vasculitis without peripheral blood eosinophilia, history of asthma, or pulmonary vasculitis (so called limited form of Churg-Strauss syndrome). Temporal artery biopsy in the 2nd patient revealed small vessel necrotizing vasculitis in the fragment of skeletal muscle surrounding a normal temporal artery (i.e., negative for giant cell arteritis, GCA). This patient subsequently developed rheumatoid polysynovitis. The temporal artery biopsies in the remaining 2 patients showed vasa vasorum vasculitis, without GCA, associated with malignancy in Patient 3 and as an unexpected and apparently isolated finding in Patient 4. All 4 patients responded to the standard corticosteroid therapy for giant cell temporal arteritis. Unusual temporal artery biopsies such as these should be interpreted in relation to clinical findings.

Adrenal Cortex Hormones↗
PubMed2000

[Lymphoma involving the temporal artery].

Involvement of the temporal arteries, considered to be the hallmark of giant cell arteritis, is rather rare in other pathologic processes. We describe a patient with lymphoma involving temporal artery. A 68-year-old man has been followed closely without therapy since 1989 for a low-grade non-Hodgkin lymphoma. He presented in 1995 with asymptomatic nodules on the temporal artery with preservation of the pulse. Temporal artery biopsy showed periarterial infiltration of mononuclear cells in keeping with follicular mixed cell lymphoma. The differential diagnosis of temporal arteritis must therefore, include other vasculitides, light chain amyloidosis but also lymphoma and emphasize the need for a temporal artery biopsy.

Biopsy↗
PubMed1998

New superselective intra-arterial infusion via superficial temporal artery for cancer of the tongue and tumour tissue platinum concentration after carboplatin (CBDCA) infusion.

We developed a new technique of superselective intra-arterial chemotherapy for tongue cancer using a modified (1.35 mm) angiographic catheter. The catheter was confirmed to be inserted into the lingual artery by the new technique. We measured the platinum concentrations in resected tumour tissues after infusion of carboplatin (CBDCA) at 20 mg/m2 over 30 min from 30 min before tumour resection in 12 patients with cancer of the tongue (6 patients: superselective intra-arterial infusion; 6 patients: conventional intra-arterial infusion). The mean platinum concentration in tumour tissue was 10.5 +/- 1.2 micrograms/g wet, which was more than twice higher than, and significantly different from, 4.3 +/- 3.8 micrograms/g wet by the conventional intra-arterial infusion method. This new superselective intra-arterial infusion method allows direct infusion of the anticancer agent into the artery supplying the tumour and is expected to become a new therapeutic modality for cancer of the tongue.

Antineoplastic Agents↗
PubMed2002

Vertebral artery-posterior inferior cerebellar artery bypass with a superficial temporal artery graft to treat aneurysms involving the posterior inferior cerebellar artery.

OBJECT: In patients with aneurysms that require occlusion of the posterior inferior cerebellar artery (PICA), revascularization of this artery should be performed. A novel surgical method for revascularization of the PICA is presented. METHODS: After a segment of the superficial temporal artery (STA) was harvested, the aneurysm was treated by trapping, followed by placement of a vertebral artery (VA)-PICA bypass in which the STA segment was used as a graft. When the length of the proximal PICA was inadequate, the distal end of the STA was anastomosed to the proximal PICA in an end-to-side fashion. When the length of the proximal PICA was adequate, the STA was anastomosed to the proximal PICA in an end-to-end fashion. In either case, the proximal end of the STA was anastomosed to the VA in an end-to-side fashion. This procedure was used in nine patients whose aneurysms involved the PICA. Although partial lateral medullary syndrome developed in one of them, follow-up evaluation revealed graft patency in all patients. There were no instances of recurrent hemorrhage or ischemia. CONCLUSIONS: Although this procedure requires harvesting of an STA graft and two anastomoses, it facilitates anterograde flow to the PICA territory. It also involves minimal mobilization of brainstem perforating vessels and the proximal PICA.

Adult↗
PubMed1999

[Great vessel and temporal artery involvement in temporal arteritis].

The importance of this case report resides in the unusual initiation of an arterial inflammatory disease. The patient presented ischemic symptoms and signs with bilateral upper limb claudication and Raynaud's phenomenon, with ulcerations on her left hand. We describe the patient's clinical history, diagnosis and therapy.

Aged↗
PubMed1993

Anastomosis of occipital artery to anterior inferior cerebellar artery with interposition of superficial temporal artery. Case report.

A 56-year-old man with vertebrobasilar insufficiency and associated findings including quadriparesis, dysarthria, cerebellar ataxia, nystagmus, and somnolence underwent left occipital artery (OA) to anterior inferior cerebellar artery (AICA) anastomosis with interposition of a superficial temporal artery (STA) graft. This procedure was chosen because cerebral angiograms demonstrated occlusion of the right vertebral artery (V3) and severe stenosis of the V4 segment of the left vertebral artery, with perfusion of the territory of the left posterior inferior cerebellar artery via the ipsilateral AICA, and because dissection of the OA is a relatively difficult and time-consuming procedure. Dissection of the STA, on the other hand, is much easier. Preoperative measurements of local cerebral blood flow in the vertebrobasilar circulation before and after intravenous administration of acetazolamide (500 mg) were obtained, and demonstrated low flow and hemodynamic compromise in the posterior circulation. The patient's hemodynamic and neurological status improved following surgery. In this report, we present a new and simplified method of OA-AICA anastomosis with interposition of STA graft.

Anastomosis, Surgical↗
PubMed2003

The role of 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography in the diagnosis of giant cell arteritis of the temporal arteries.

OBJECTIVE: As one of the diagnostic criteria for giant cell arteritis affecting the temporal arteries (temporal arteritis) is still biopsy-proven vasculitis of the affected artery, the aim of our study was to evaluate the value of a non-invasive procedure, 2-(18)F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (F-18-FDG-PET), in the diagnosis of Horton's disease. METHODS: During a period of 10 months, 22 consecutive patients with the clinical diagnosis of giant cell arteritis and a positive hypoechogenic halo in duplex sonography were re-examined with F-18-FDG-PET. Six patients had giant cell arteritis involving both the large arteries and the temporal arteries; five patients showed giant cell arteritis only in the large arteries without concomitant involvement of the temporal arteries, and the remaining 11 patients showed only involvement of the temporal arteries. All patients were examined by sonography and F-18-FDG-PET, which was performed before treatment with corticosteroids. RESULTS: All patients with positive signs of giant cell arteritis in duplex sonography, i.e. a hypoechogenic halo in the large arteries (thoracic, subclavian, axillary, iliac, aorta), also showed elevated FDG uptake in the same vessels, with complete agreement in the anatomical distribution of changes. When positive sonography was limited to the temporal arteries, FDG-PET was completely negative in the temporal arteries and all other arterial locations. CONCLUSION: PET is not yet suitable for the diagnosis of temporal arteritis and therefore cannot replace invasive biopsy. F-18-FDG-PET is well suited to the demonstration of giant cell arteritis in arteries exceeding 4 mm in diameter.

Aged↗
PubMed1995

Anastomosis of occipital artery to posterior cerebral artery with interposition of superficial temporal artery using occipital interhemispheric transtentorial approach: case report.

BACKGROUND: Superficial temporal artery (STA)-superior cerebellar artery (SCA) anastomosis, and STA-posterior cerebral artery (PCA) anastomosis are considered suitable as surgical procedures for the treatment of patients with significant stenosis or occlusion in the rostral portion of the basilar artery and patients with significant stenosis or occlusion of the posterior cerebral artery, respectively. However, several authors have reported frequent and serious complications of these surgical procedures, including temporal lobe retraction edema and hematoma. In this study, we introduce a new surgical revascularization using an occipital interhemispheric transtentorial approach for the treatment of severe stenosis of the rostral portion of the basilar artery. CASE REPORT: A 47-year-old man with hypertension noted the sudden onset of nuchal pain followed by vertigo, diplopia, drunken gait, and motor weakness on his right side. Angiography performed on the day of the onset disclosed severe stenosis of the basilar artery. The stenotic portion extended just distal to the anterior-inferior cerebellar artery (AICA) to just proximal to the SCA, and in addition, a pseudolumen was visualized just distal to the left AICA. The patient underwent right occipital artery (OA) to left PCA anastomosis with interposition of the STA using an occipital interhemispheric transtentorial approach. Marked improvement in dysarthria, diplopia, ataxia gait, and visual disturbance were noted and he was able to walk without aid 3 days after operation. A postoperative angiogram of the right OA obtained 25 days after operation demonstrated visualization of the left PCA via the anastomosed OA and STA graft. CONCLUSIONS: OA-PCA anastomosis with interposition of STA graft using an occipital interhemispheric transtentorial approach can be substituted for STA-SCA anastomosis and STA-PCA anastomosis for treatment of stenosis/occlusion of the rostral portion of the basilar artery.

Anastomosis, Surgical↗
PubMed1997

Revascularization of the anterior cerebral artery using a free superficial temporal artery graft: a case report.

BACKGROUND: Various bypass procedures have been used to treat occlusive cerebrovascular diseases. Most procedures were performed to prevent further ischemia in the territory of the middle cerebral artery, while only a few of the papers discuss the anterior cerebral artery (ACA) territory. METHOD AND RESULTS: A patient who initially presented with several episodes of transient monoparesis in the left leg was found to have severe stenosis of the right A2-A3 junction. A free superficial temporal artery (STA) graft was anastomosed between the right A2 and A3 portion intracranially. Transient ischemic attacks immediately disappeared after surgery and subsequent cerebral angiography revealed good anterograde filling from the A2 to A3 portion via the free STA graft. CONCLUSION: Revascularization using a free STA graft is useful for reconstruction of a local stenotic lesion, especially in the ACA territory.

Adult↗
PubMed1987

Clinical usefulness of temporal artery biopsy.

To assess the diagnostic usefulness of temporal artery biopsy in temporal arteritis (TA) and establish clinical features capable of predicting its positivity we have retrospectively studied the biopsy specimens and the clinical features of 103 patients who had undergone temporal artery biopsy. Temporal artery biopsy reached a positive predictive value of 90.2% with respect to the final diagnosis based on the criteria proposed by Ellis and Ralston and the clinical course. The simultaneous presence of recent onset headache, jaw claudication, and abnormalities of the temporal arteries on physical examination had a specificity of 94.8% with respect to the histological diagnosis and of 100% with respect to final diagnosis. The presence of any of these clinical features, though of little specificity (34.4%), had a sensitivity of 100% with respect to histological diagnosis, selecting a group of patients in whom temporal artery biopsy has more discriminative value.

Adult↗
PubMed1996

Pseudoaneurysm of the anterior superficial temporal artery.

Pseudoaneurysm of the superficial temporal artery must be considered in the differential diagnosis of masses of the lateral forehead and temporal fossa. While the first reported case of a temporal artery aneurysm was reported by Thomas Bartholin in 1740, there is scant mention of this lesion in the plastic and maxillofacial surgical literature. Pseudoaneurysms can arise in the forehead and scalp as a result of blunt traumatic impingement of the superficial temporal artery against the calvarium. The anterior branch of the artery is most vulnerable, because in the lateral forehead it courses over the frontal osseous ridge in the galea aponeurotica formed by the fusion line of the deep and superficial temporalis muscle fascia. This dense fascial investment has a tethering effect in the gap between the temporalis and frontalis muscles and prevents the artery from displacing laterally in response to traumatic forces. A history of recent blunt trauma or surgery to the forehead, combined with a pulsatile bruit, should direct the physician to the diagnosis of pseudoaneurysm of the superficial temporal artery. Treatment is surgical resection of the involved segment without the need for reconstruction. This report includes a review of the literature and presents the first documented case of a bicycle helmet as the cause of a superficial temporal artery pseudoaneurysm.

Adult↗
PubMed1995

Histamine actions in dog retinal central arteries as compared to those in middle cerebral and temporal arteries.

PURPOSE: Mechanisms underlying the relaxant response to histamine were compared in isolated dog retinal arteries (branch of internal and external carotid arteries), middle cerebral arteries (branch of internal carotid artery) and superficial temporal arteries (branch of external carotid artery). METHODS: Changes in the isometric tension of helical strips of the arteries with and without the endothelium were recorded. RESULTS: Histamine produced concentration-related biphasic (phasic and sustained) relaxations in retinal arterial strips contracted partially with prostaglandin (PG)F2 alpha. Relaxations induced by histamine were not dependent on the endothelium. Treatment with cimetidine attenuated the sustained relaxation, whereas chlorpheniramine or indomethacin depressed the phasic relaxation. In addition, the phasic relaxant response to histamine was attenuated by tranylcypromine, a PGI2 synthesis inhibitor. In contrast, the amine-induced relaxant responses in dog middle cerebral arterial branch and temporal arteries were markedly suppressed by cimetidine alone. CONCLUSIONS: In dog retinal arteries, the phasic relaxation caused by histamine is mediated by PGI2 in association with activation of the H1 receptor subtype in subendothelial tissues, possibly smooth muscle, and the sustained relaxation is evoked by direct stimulation of the H2 receptor subtype in smooth muscle. The histamine-induced relaxation in temporal and distal middle cerebral arteries is associated solely with a stimulation of H2 receptors in smooth muscle.

Animals↗