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التهاب الشريان الخلوي العرطل : Giant Cell Arteritis


التهاب الشريان الخلوي العرطل : Giant Cell Arteritis

المعلومة

In an elderly patient , a new headache with scalp tenderness and
malaise means giant cell arteritis until proved otherwise : ESR and steroids in the meantime .

أي مريض مسن يشكو من صداع حديث مترافق مع إيلام بفروة الرأس و توعك فهو التهاب الشريان الخلوي العرطل ( التهاب الشريان الصدغي ) حتى يثبت العكس :
و هي حالة إسعافية تتطلب قياس سرعة تثفل الكريات الحمراء ( و عادة ما تكون مرتفعة أكثر من 60 ملم / ساعة ) , و جرعة كبيرة من الستيروئيدات .

المرجع

Essential.Neurology.4Th.Ed
© 2005 by Blackwell Publishing Ltd
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بعد التخرج

Giant cell arteritis

In elderly people, the extracranial and the intra-orbital arteries may become affected with an arteritis which is painful and dangerous. The danger lies in the fact that the lumen of these arteries may become obliterated because of the thickening of their walls and associated thrombosis.
Patients with giant cell arteritis generally feel unwell, short of energy and apathetic. The condition overlaps with polymyalgia rheumatica, in which similar symptoms are associated with marked stiffness of muscles.

The arteritis causes headache and tenderness of the scalp when resting the head on the pillow, and when brushing the hair), because of the inflamed arteries. The superficial temporal arteries may be tender, red, swollen and non-pulsatile. The condition is sometimes known as temporal arteritis because of the very frequent involvement of the superficial temporal arteries, but the facial arteries are often involved, as are other arteries in the scalp.

The arterial occlusive aspects of the disease chiefly concern the small branches of the ophthalmic artery in the orbit. Sudden and irreversible blindness due to infarction of the distal part of the optic nerve is the main danger.

Giant cell arteritis is an emergency requiring urgent estimation of the ESR (usually elevated above 60mm/hour, with an accompanying elevation in C-reactive protein) and immediate high-dose steroid treatment. In all but the most clear-cut cases, the diagnosis should be rapidly confirmed with a temporal artery biopsy. Most patients will continue to need steroids in much diminished doses for a couple of years, and sometimes for much longer

Essential.Neurology.4Th.Ed
© 2005 by Blackwell Publishing Ltd

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بتعرفوا إنو لازم أخذ خزعة حوالي 3-6 سمShocked Shocked Shocked

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معايير التشخيص 5 ويجب توفر 3
عمره اكتر من 50
سرعة التثفل اكتر من 50
صداع حديث وحيد الجابن صدغي
شذوذات في الشريان الصدغي بالفحص ( إيلام - غياب نبض تسمك - عقد )
خزعة شريان صدغي غير سوية

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