Reduction in jaw opening: a neglected symptom of giant cell arteritis

Kraemer, Markus; Metz, A.; Herold, Michèle; Venker, C.; Berlit, Peter

doi:10.1007/s00296-010-1690-0

Cited by 15 publications

(10 citation statements)

References 6 publications

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“…While these techniques have been studied extensively in the variants of giant cell arteritis (GCA) [23,24], data for the other vasculitides are sparse. In the cranial variant of GCA, ultrasound studies with duplex sonography demonstrating the halo sign are highly sensitive and specific [25]. Despite suggestive MRA or CTA, conventional angiography is often mandatory (Fig.…”

Section: First Diagnostic Steps In Suspected Cerebral Vasculitismentioning

confidence: 99%

Cerebral vasculitis in adults: what are the steps in order to establish the diagnosis? Red flags and pitfalls

Berlit

Kraemer

2014

Clinical and Experimental Immunology

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Cerebral vasculitis is a rare cause of juvenile stroke. It may occur as primary angiitis of the central nervous system (PACNS) or as CNS manifestation in the setting of systemic vasculitis. Clinical hints for vasculitis are headache, stroke, seizures, encephalopathy and signs of a systemic inflammatory disorder. Diagnostic work-up includes anamnesis, whole body examination, laboratory and cerebral spinal fluid (CSF) studies, magnetic resonance imaging (MRI), angiography and brain biopsy. Due to the rarity of the disease, exclusion of more frequent differential diagnoses is a key element of diagnostic work -up. This review summarizes the steps that lead to the diagnosis of cerebral vasculitis and describes the red flags and pitfalls. Despite considering the dilemma of angiography-negative vasculitis and false-negative brain biopsy in some cases, it is important to protect patients from 'blind' immunosuppressive therapy in unrecognized non-inflammatory differential diagnosis.

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Section: First Diagnostic Steps In Suspected Cerebral Vasculitismentioning

confidence: 99%

Cerebral vasculitis in adults: what are the steps in order to establish the diagnosis? Red flags and pitfalls

Berlit

Kraemer

2014

Clinical and Experimental Immunology

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“…[8] In addition, Kraemer et al emphasized the importance of greater analysis into individual GCA symptoms. [9] This was elucidated in their case report as the reduction of jaw opening (i.e. an atypical feature) in their patient led to the misdiagnosis of GCA as occipital neuritis and craniomandibular dysfunction.…”

Section: Discussionmentioning

confidence: 97%

“…an atypical feature) in their patient led to the misdiagnosis of GCA as occipital neuritis and craniomandibular dysfunction. [9] Furthermore, GCA can also be associated with other diseases such as Takayasu arteritis. [10] Despite the literature being laden with several diagnostic dilemmas concerning GCA, our case report is unique in terms of being the only one where GCA was misdiagnosed as tension-type headache.…”

Section: Discussionmentioning

confidence: 99%

Giant cell arteritis or tension-type headache?: A differential diagnostic dilemma

Rana

Saeed

Khan³

et al. 2014

Journal of Neurosciences in Rural Practice

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Giant cell arteritis (GCA) or Temporal arteritis (TA) is an autoimmune disease and the most common type of vasculitis in the elderly. It causes inflammation of the medium and large arteries in the upper part of the body. GCA is an under-recognized cause of head aches in the elderly, especially when it presents itself with atypical features, resulting in delayed or incorrect diagnosis. Since GCA is a treatable condition, an accurate diagnosis is crucial to prevent the most serious complication of CGA, permanent vision loss. The diagnosis can be further complicated as GCA may present with features of other painful neurological conditions. The present case is an 81-year-old woman diagnosed with GCA, who initially presented with features similar to tension-type headache. Due to overlapping features of these conditions, the diagnosis of GCA was delayed, resulting in irreversible vision loss. Although previous research highlights diagnostic dilemmas featuring GCA and other disease states, this case is exclusive in describing a unique dilemma where tension-type headache mimics GCA.

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“…105 Recently, a reduction in jaw opening (trismus) has also been proposed as a rare symptom for GCA. 106 Intracranial arteries are usually spared in GCA; however, Goedhart-de Haan et al 107 described a case with occipital infarction due to vertebral artery vasculitis caused by GCA.…”

Section: Giant Cell Arteritismentioning

confidence: 97%