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At least 19 recordsLinked to original sources
PubMed1997

Systemic amyloidosis with temporal artery involvement mimicking temporal arteritis.

A 77-year-old man presented with jaw claudication, arthralgias and myalgias, weight loss, marked fatigue, and thickened temporal arteries. No vasculitis was seen on the temporal artery biopsy specimen, but amyloidosis was suspected and confirmed with Congo red staining. Subsequent bone marrow biopsy revealed multiple myeloma. Although the patient initially was thought to have temporal arteritis, the results of temporal artery biopsy directed further investigations that led to the diagnosis of systemic amyloidosis. Systemic amyloidosis should be considered in the differential diagnosis when patients, especially men, present with clinical findings suggestive of temporal arteritis but without evidence of vasculitis in temporal artery biopsy specimens.

Aged↗
PubMed1999

The posterior temporal artery as the recipient in superficial temporal artery to posterior cerebral artery bypass. Technical note.

BACKGROUND: While superficial temporal artery (STA) to superior cerebellar artery (SCA) or STA to posterior cerebral artery (PCA) anastomosis has been used for rostral brain stem ischemia, it is reported not infrequently to be associated with serious complications. Although the inferior temporal artery has been proposed as a possible recipient artery for the STA, its advantage is not yet widely recognized. CASE REPORT: A 42-year-old man presented with repeated loss of vision in the left visual field. Angiography disclosed occlusion in the proximal portion of the P2 segment of the right PCA. The second case was a 68-year-old man experiencing swallowing disturbance; the bilateral vertebral arteries were markedly stenotic. Since hemodynamic insufficiency was considered to be responsible for the patients' symptoms, STA-PCA anastomosis was performed using the posterior temporal artery (PTA) as the recipient. The postoperative courses were uneventful with good patency of the bypass. TECHNIQUE: Through a horizontally extended temporal craniotomy with the base of the temporal bone sufficiently drilled away, the inferior aspect of the temporal lobe was searched for a recipient artery for the STA. The anastomosis was performed with less difficulty and at a shallower level, by 20 mm in one case and by 10 mm in the other, than had we anastomosed it to the P2 segment of the PCA. CONCLUSION: Anastomosis of the STA to the PTA is less complicated than anastomosis of the STA to the main branch of the PCA for the treatment of rostral brain stem ischemia.

Adult↗
PubMed1999

Epithelioid hemangioma of the temporal artery clinically mimicking temporal arteritis.

A rare case of epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia) arising in the right temporal artery of a 68-year-old Japanese woman was investigated. The patient had been treated with corticosteroids (Predonine 5 mg/day p.o.) for 4 years for idiopathic thrombocytopenic purpura. Headaches in the right temporal region with repeated high fevers first appeared 1 year prior to the biopsy of a nodule at the artery. The clinical diagnosis was temporal arteritis (giant cell arteritis). The specimen consisted of a short segment of the superior arterial branch having a sheet-like proliferation of the epithelioid endothelial cells in the lumen, which was almost occluded, focal rupture of the media, and marked proliferation of the capillaries (neovascularization) radiating out from the media to the adventitia. There were scattered foci of inflammatory cell infiltration composed mainly of small lymphocytes in the adventitia, but there were no histological changes suggestive of giant cell arteritis. The lesion was thus characterized by the proliferation of epithelioid endothelial cells in the lumen of the artery, and neovascularization between the media and adventitia. The histological features were very close to epithelioid hemangioma except for the absence of an eosinophilic reaction. The long-term administration of corticosteroids may have suppressed it. The authors believe this is the first case of epithelioid hemangioma arising from the temporal artery without a history of trauma. It showed some unique features both clinically and histopathologically, which contributed to the study of the yet not clearly classified vascular proliferative lesion, epithelioid hemangioma.

Aged↗
PubMed1999

[Temporal artery biopsy].

Temporal artery biopsy is performed to confirm the diagnosis of giant cell arteritis. This proof is quite absolute and allows using corticosteroid treatment associated with considerable morbidity in elderly patients. Biopsy is necessary in patient supposed to suffer from giant cell arteritis. Treatment test, which is often difficult to interpret, is done only when temporal artery biopsy is impossible. The biopsy is easy, bilateralisation improves its efficiency. Sometimes the temporal artery biopsy allows to diagnose other vasculitides. Although this biopsy is easy, a strict clinical reflexion must precede its realisation.

Biopsy↗
PubMed1982

Histologic and ultrastructural characteristics of temporal arteritis. The value of the temporal artery biopsy.

Temporal artery biopsy is an easily performed procedure of low morbidity that produces valuable information in establishing a diagnosis and guiding therapy as well as providing tissue for further pathologic and immunologic research aimed at understanding and ultimately controlling this disease. The pathogenesis of temporal arteritis remains unresolved. In an effort to clarify this question, 19 temporal arteries demonstrating typical arteritic changes by light microscopy were also examined by transmission electron microscopy. At the light microscopic level, a granulomatous inflammation, often containing giant cells, was found in all layers of the vessel but most commonly concentrated within the internal or external border of the muscular media. The internal elastic lamina was usually fragmented and surrounded by inflammatory cells. Segmented subintimal fibromuscular hyperplasia and lymphocytic and plasma cell infiltration of the adventitia were nondiagnostic but suggestive findings commonly observed. Ultrastructural alterations were most striking in the muscular media. Degenerating smooth muscle cells with elongated mitochondria, dilated rough endoplasmic reticulum, and autophagic vacuoles containing electron-dense material were observed. Macrophages and giant cells contained degenerated smooth muscle cell basement membrane within phagocytic vacuoles, and macrophages were found within smooth muscle. Although frequently found in the vicinity of macrophages and giant cells, disrupted elastic lamina was not demonstrated in phagocytic cells.

Biopsy↗
PubMed1991

How to perform a temporal artery biopsy.

Temporal artery biopsy is performed to confirm the diagnosis of giant cell arteritis. The technique is described together with the anatomy of the superficial temporal artery.

Biopsy↗
PubMed1993

[Indications for biopsy of the temporal artery].

Indications for Temporal Artery Biopsy are often discussed in the diagnosis of temporal arteritis. In this retrospective study we have reviewed the clinical records of 150 patients who underwent temporal artery biopsy between 1983 and 1990 in Kantonsspital Aarau/Switzerland. In 18.6% biopsies were histologically classified as temporal arteritis. To judge the indication for temporal artery biopsy the combination of symptoms leading to biopsy and the histologic results were compared. Symptoms were divided in unspecific, such as fever, loss of weight or malaise, and more specific symptoms as headache, jaw claudication, loss of visual acuity and diplopia, tenderness of temporal artery, or polymyalgia rheumatica. In conclusion the result of this study is that temporal artery biopsy may be an important help in the diagnosis of temporal arteritis in cases with one or two specific symptoms, at which polymyalgia rheumatica is a questionable indication. In our opinion temporal artery biopsy is not indicated in cases with isolated elevation of ESR, one or more unspecific symptoms and three or more specific symptoms, because there no diagnostic profit can be suspected.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Distribution and effects of neuropeptide Y, vasoactive intestinal peptide, substance P, and calcitonin gene-related peptide in human middle meningeal arteries: comparison with cerebral and temporal arteries.

A sparse to moderate supply of nerve fibers containing neuropeptide Y-like immunoreactivity (NPY-LI), vasoactive intestinal polypeptide (VIP-LI), substance P (SP-LI), and calcitonin gene-related peptide (CGRP-LI) was demonstrated in the walls of human middle meningeal arteries. Comparison with similar studies on human cerebral and temporal arteries indicated a similar distribution and density. The immunoreactive material in all three arterial regions was characterized by reversed-phase high pressure liquid chromatography (HPLC) and radioimmunoassay (RIA). The major peak of NPY-LI, VIP-LI, SP-LI, and CGRP-LI in each extract eluted approximately with the same elution volume as that of the corresponding synthetic analogues. The concentration of NPY in the middle meningeal arteries was lower as compared to the temporal arteries. Low concentrations of SP-LI and CGRP-LI were found in the middle meningeal arteries as compared to the cerebral arteries. In isolated ring segments of human middle meningeal and cerebral arteries, NPY caused vasoconstriction but did not potentiate the contractile response of noradrenaline. In the temporal artery, NPY did not induce contraction but potentiated the vasoconstrictor response to noradrenaline. Vasoactive intestinal polypeptide, peptide histidine methionine-27, SP, neurokinin A, and CGRP relaxed all three types of cephalic arteries. The peptide effects were not antagonized by propranolol, atropine, or cimetidine. Comparison of the responses to VIP and SP of vessels from the different regions showed a similar pattern of reactivity. The response to SP was slightly (p less than 0.05) more potent, whereas the responses to CGRP were less potent in the middle meningeal as compared to that in cerebral (p less than 0.005) vessels.

Acetylcholine↗
PubMed1997

[Biopsy of the temporal artery].

Horton temporal arteritis, or gigantocellular arteritis, is a panarteritis involving the mid-size and large arteries, in particular the temporal surface artery. This pathology is normally found in the elderly, particularly females. It can be manifest with some typical symptoms (i.e. cephalea, fever, visual disorders even leading to blindness mandibular claudication, high ESR, moderate anemia), there may be aspecific, atypical signs (i.e. only cephalea and fever, or widespread myalgia and artralgia) or it may arise following a cerebro-vascular accident. Treatment of this form of arteritis is based on the use of high doses of corticosteroids over a long period of time (at least 1-2 years). The present work describes a surgical technique for biopsying the temporal artery. The technique consists of withdrawal of a segment of the artery from the main branch and the frontal branch of the temporal surface artery. Since this form of arteritis often presents segmentary lesions, it is advisable to take a 4-5 cm sample so as to prevent false negatives. This simple surgical procedure can be performed under local anesthesia and is practically complication-free. The authors then discuss the indications for temporal artery biopsy and report 3 clinical cases (case no. 1 is an example of the classical manifestation while cases no. 2 and 3 are atypical, aspecific forms). Since both the classical and atypical forms of gigantocellular arteritis require high doses of corticosteriods over a long period of time, the temporal artery biopsy procedure is highly useful in formulating an accurate diagnosis. The well known side effects to long-term cortisone use make it necessary to use all the available instruments in making the correct diagnosis. Bilateral biopsy can be performed in those cases where the first biopsy proved negative but gigantocellular arteritis is still suspected.

Aged↗
PubMed1998

[Vasculitis in the temporal artery--found not only in temporal arteritis].

Vasculitis in the temporal artery is almost pathognomonic for temporal arteritis. Inflammatory changes in the temporal artery has also been reported in other primary vasculitis disorders like polyarteritis nodosa, Wegener's granulomatosis and Churg-Strauss syndrome. New observations may even indicate that vasculitis in the temporal artery is quite common in cases of polyarteritis nodosa. A correct diagnosis; is important, due to the differences in treatment and prognosis for these diseases.

Aged↗
PubMed2000

Chlamydia pneumoniae not detected in temporal artery biopsies from patients with temporal arteritis.

In a recent report Chlamydia pneumoniae (C. pneumoniae), examined with both immunohistochemistry and polymerase chain reaction (PCR), was detected in positive temporal artery biopsies from patients with temporal arteritis (TA). Our aim was to examine whether C. pneumoniae could be detected in patients with TA recruited from a high endemic area of TA in southern Norway. Twenty paraffin-embedded temporal artery biopsies showing convincing inflammation in the vessel wall with lymphocytic infiltration (giant cells in 12 biopsies) from 20 patients with TA were examined for the presence of C. pneumoniae using an established PCR technique. All examined TA patients (mean age 74.4 (SD 7.5) years, 75% females) fulfilled the ACR-1990 criteria. C. pneumoniae was not detected in any of the biopsies. In conclusion, our results indicate that C. pneumoniae, at least in the population of southern Norway, does not have any pathogenetic role in TA.

Aged↗
PubMed2001

Healed or quiescent temporal arteritis versus senescent changes in temporal artery biopsy specimens.

Temporal arteritis (TA) is a common idiopathic vasculitis of the elderly. It is controversial whether, in the absence of an active inflammatory process, vessel damage secondary to temporal arteritis is distinguishable from changes secondary to arteriosclerosis. The primary goal of this study was to attempt to differentiate microscopically between healed temporal arteritis and arteriosclerosis, in the absence of active vasculitis. This was a retrospective study in which 47 temporal artery biopsy specimens, done between 1981 and 1997 at University of British Columbia Hospital, were reviewed. As well, temporal arteries harvested from 10 autopsy cases with no clinical evidence of vasculitis were used as controls. Haematoxylin and Eosin and Movat's pentachrome stains were used to assess the degree of intimal thickening, presence or absence of inflammation, type of inflammatory cell(s), the degree of reduplication of elastic lamina, calcification, fibrosis, neovascularisation and gaps or losses in the internal and external elastic lamina. No histological findings were specific for temporal arteritis except the presence of mural inflammation. A high degree of variability existed for all other features assessed, within all groups studied. These results indicate that, in the absence of active inflammation, structural changes in the vessel wall do not allow reliable differentiation between healed or quiescent temporal arteritis and arteriosclerosis. The common practice of performing special stains in all temporal artery biopsy cases does not contribute to the ability to recognise temporal arteritis.

Aged↗
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↗