Abstract:Giant cell arteritis (GCA) is a systemic autoimmune disease that affects medium- and large-sized arteries. The diagnostic gold standard is the temporal artery biopsy, but it has limited sensitivity and some difficulties in reproducibility. Color duplex ultrasonography is a noninvasive, reproducible, and inexpensive method for diagnosis of temporal arteries involvement (temporal arteritis [TA]) in GCA with high sensitivity and specificity. We present the ultrasound findings at baseline and during follow-up in a… Show more
“…That for distal frontal ramus was 2.5 cm (Fig. 2) [15]. Ultrasound examinations had performed by ultra-sonographers (minimum 3-years’ experience, blinded regarding physical features, clinical examinations, temporal artery biopsy examinations, and MRI examinations) of the institute.Fig.…”
Background
Diagnosis of giant cell arteritis by temporal artery biopsy is time-consuming and visual loss lies in the first week after its diagnosis. The purpose of the study was to test the hypothesis that ultrasound can reduce the risk of overdiagnosis and overtreatment in giant cell arteritis.
Methods
Data regarding physical/ clinical features examinations, temporal artery biopsy examinations, ultrasound findings, and magnetic resonance imaging examinations of 980 suspected patients for giant cell arteritis were included in the study. Decision curve analysis was applied to get a beneficial score for selected diagnostic modalities. Cost analysis was performed for each patient.
Results
Fewer numbers of false positive giant cell arteritis results were reported under physical/ clinical features examinations following ultrasound detection than physical/clinical features examinations following temporal artery biopsy examinations (45 vs. 127,
p
< 0.0001). The working area that detects giant cell arteritis at least one time for physical/ clinical features examinations following ultrasound detection and physical/ clinical features examinations following temporal artery biopsy examinations were 0–91% and 0–86%. No significant difference for true negative results between magnetic resonance imaging and physical and clinical features examinations following ultrasound detection (
p
= 0.007). Physical and clinical features examinations following ultrasound detection were less expensive method than physical/ clinical features examinations following temporal artery biopsy examinations (14,023 ± 982 ¥/patient vs. 18,551 ± 1231 ¥/patient,
p
< 0.0001) and MRI.
Conclusion
Physical and clinical features examinations following ultrasound are recommended for diagnosis of patients with suspected giant cell arteritis.
“…That for distal frontal ramus was 2.5 cm (Fig. 2) [15]. Ultrasound examinations had performed by ultra-sonographers (minimum 3-years’ experience, blinded regarding physical features, clinical examinations, temporal artery biopsy examinations, and MRI examinations) of the institute.Fig.…”
Background
Diagnosis of giant cell arteritis by temporal artery biopsy is time-consuming and visual loss lies in the first week after its diagnosis. The purpose of the study was to test the hypothesis that ultrasound can reduce the risk of overdiagnosis and overtreatment in giant cell arteritis.
Methods
Data regarding physical/ clinical features examinations, temporal artery biopsy examinations, ultrasound findings, and magnetic resonance imaging examinations of 980 suspected patients for giant cell arteritis were included in the study. Decision curve analysis was applied to get a beneficial score for selected diagnostic modalities. Cost analysis was performed for each patient.
Results
Fewer numbers of false positive giant cell arteritis results were reported under physical/ clinical features examinations following ultrasound detection than physical/clinical features examinations following temporal artery biopsy examinations (45 vs. 127,
p
< 0.0001). The working area that detects giant cell arteritis at least one time for physical/ clinical features examinations following ultrasound detection and physical/ clinical features examinations following temporal artery biopsy examinations were 0–91% and 0–86%. No significant difference for true negative results between magnetic resonance imaging and physical and clinical features examinations following ultrasound detection (
p
= 0.007). Physical and clinical features examinations following ultrasound detection were less expensive method than physical/ clinical features examinations following temporal artery biopsy examinations (14,023 ± 982 ¥/patient vs. 18,551 ± 1231 ¥/patient,
p
< 0.0001) and MRI.
Conclusion
Physical and clinical features examinations following ultrasound are recommended for diagnosis of patients with suspected giant cell arteritis.
“…Several studies also showed a potential benefit of ultrasonographic follow-up in patients exhibiting the halo sign at baseline, with evidence of regression of the wall edema in most cases, once steroid treatment was initiated. [6,7,8,9]. However, there is lack of congruence between the mean time to halo disappearance, ranging from 7 days in one case report [7] to a mean of 11 weeks in a 30 patients cohort study [9], with both using the 0.3 mm threshold in defining the halo sign.…”
Section: Discussionmentioning
confidence: 99%
“…[6,7,8,9]. However, there is lack of congruence between the mean time to halo disappearance, ranging from 7 days in one case report [7] to a mean of 11 weeks in a 30 patients cohort study [9], with both using the 0.3 mm threshold in defining the halo sign. One case report showed a negative halo sign after 2 days of treatment [10].…”
Section: Discussionmentioning
confidence: 99%
“…It also added to the observational inference that halo monitoring may be useful in asessing arteritic flares. Others even raised the possibility of using CDUS as a method for early detection of relapses [7]. However, establishing a gold standard for comparison remains problematic, with the ideal option of repeated biopsies rendered unethical.…”
Giant cell arteritis is a common systemic vasculitis affecting the elderly, with maximum prevalence in the 7th decade of age, targeting aortic derived medium and large vessels of the neck and head. Diagnosis is established on a biopsy specimen of the temporal artery wall, through pathological confirmation of panarteritis, typically characterized by mononuclear cell infiltrate, with the 1990 ACR criteria often used in clinical practice.
We present the case of a patient with a new onset headache and systemic inflammation, who did not fulfil the classical diagnostic criteria, nor did the temporal artery biopsy (TAB) provide a positive result. However, the ultrasonographical features, clinical evolution and response to corticosteroid therapy confirmed the diagnosis. This patient had bilateral presence of the halo sign on color duplex ultrasonography (CDUS), cited as a highly specific feature, when compared to the ACR criteria as a standard reference. We employed its positive likelihood-ratio (LR+) of 43 as previously estimated, while considering a low pre-test probability for a positive diagnosis (15%), to calculate a post-test probability of 88%, leading to our decision to treat him as having giant cell arteritis. Remission of the headache and rebound phenomena when tapered off steroid therapy substantially contributed to the positive diagnosis, underlining the importance of future studies needing to use clinical evolution as a reference standard.
“…Zajęta tętnica skroniowa może być wyczuwalna, tkliwa i niepodatna na ucisk. U ok. 30% chorych może wystąpić jednostronna ślepota spowodowana przez zamknięcie światła tętnicy środkowej siatkówki [19,20]. Tarcza nerwu wzrokowego może być prawidłowa, blada lub obrzęknięta, z krwotokami na powierzchni siatkówki.…”
Central and peripheral nervous system vascular disorders are a heterogeneous group of diseases, divided into primary and secondary inflammations. In primary vasculitis, the lesions are limited to the nervous system, without inflammatory changes in the vessels of other organs. In secondary vasculitis the nervous system vasculitis accompanies systemic diseases. Nervous system vasculitis is associated with a variety of neurological symptoms and their combinations, which makes diagnosis difficult. The aim of this publication is to review the current neurological symptomatology and the diagnostic and therapeutic possibilities in the treatment of vasculitis. Keywords: primary vasculitis; secondary vasculitis; nervous system.
ABSTRAKTZapalenia naczyń ośrodkowego i obwodowego układu nerwowego stanowią heterogenną grupę chorób. Dzieli się je na zapalenia pierwotne i wtórne. W pierwotnych zapaleniach naczyń zmiany ograniczają się do układu nerwowego, bez zmian zapalnych w naczyniach innych narządów. Jako wtórne natomiast określa się zapalenia naczyń, w których zajęcie układu nerwowego towarzyszy chorobom ogólnoustrojowym. W przebiegu zapalenia naczyń układu nerwowego występuje różnorod-ność objawów neurologicznych i ich kombinacje, co sprawia, że są trudne do rozpoznania. Celem niniejszej publikacji był przegląd aktualnej symptomatologii neurologicznej oraz możliwości diagnostycznych i terapeutycznych w przebiegu zapalenia naczyń układu nerwowego. Słowa kluczowe: pierwotne zapalenia naczyń; wtórne zapalenia naczyń; układ nerwowy.
WSTĘPZapalenia naczyń układu nerwowego stanowią heterogenną grupę chorób. Dzieli się je na zapalenia pierwotne i wtórne. W pierwotnych zapaleniach naczyń zmiany ograniczają się do układu nerwowego, bez zmian zapalnych w naczyniach innych narządów. Jako wtórne natomiast określa się zapalenia naczyń, w których zajęcie układu nerwowego towarzyszy chorobom ogólnoustrojowym. Zarówno w pierwotnych, jak i wtórnych zapaleniach naczyń układu nerwowego głównym powodem wystąpienia objawów klinicznych jest niedokrwienie [1, 2].W przebiegu zapalenia naczyń układu nerwowego wystę-pują różnorodne objawy neurologiczne jako odzwierciedlenie ogniskowego, wieloogniskowego lub rozlanego uszkodzenia układu nerwowego [3]. Najczęstszymi objawami są bóle głowy, ogniskowe lub uogólnione napady padaczkowe, przemijające ataki niedokrwienia mózgu, udary niedokrwienne lub krwotoczne, zaburzenia funkcji poznawczych, neuropatie obwodowe i neuropatie nerwów czaszkowych [4]. Przebieg kliniczny może być ostry, podostry lub przewlekły z okresami zaostrzeń i remisji. Różnorodność objawów neurologicznych i ich kombinacji sprawia, że zapalenia naczyń układu nerwowego są trudne do rozpoznania [5].W praktyce klinicznej w rozpoznaniu zapaleń naczyń układu nerwowego pomocne są badania neuroobrazowe, w tym wizualizacja małych naczyń mózgowych. Podejrzenie zapalenia naczyń układu nerwowego, wsparte neuroobrazowaniem, wymaga rozszerzenia panelu badań zmierzających do wykrycia podłoża immunologiczno-zapalnego obserwowanych objawów ne...
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