The role of unilateral temporal artery biopsy

Hall, Jocelin; Volpe, Nicholas J.; Galetta, Steven; Liu, Grant T.; Syed, Nasreen A.; Balcer, Laura J.

doi:10.1016/s0161-6420(02)01758-x

Cited by 57 publications

(36 citation statements)

References 7 publications

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“…However, another study by Hall et al found that out of 88 patients with negative unilateral TA biopsies, 1% (1 subject) had a subsequent positive contralateral biopsy. While bilateral TA biopsies may be necessary for patients in whom GCA is highly suspected, a unilateral TA biopsy may suffice in cases where the suspicion for GCA is low (Hall et al, 2003).…”

Section: Temporal Artery Biopsymentioning

confidence: 99%

Giant Cell Arteritis

Tehrani

Ostrowski

Hariman

et al. 2008

Seminars in Ophthalmology

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This review summarizes the diagnosis, clinical manifestations and management of giant cell arteritis. Giant cell arteritis is an immune-mediated vasculitis of medium to large sized arteries that affects individuals older than the age of 50. Patients typically present with signs of vascular insufficiency of the extracranial arteries of the head and systemic inflammation. Temporal artery biopsy remains the hallmark of diagnosis. Specific treatment regimens must be tailored to each individual, but steroids remain the backbone of therapy.

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Section: Temporal Artery Biopsymentioning

confidence: 99%

Giant Cell Arteritis

Tehrani

Ostrowski

Hariman

et al. 2008

Seminars in Ophthalmology

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“…[42][43][44] In cases with a relatively low clinical suspicion of the disease, one negative biopsy is generally sufficient. 45 In cases when the clinical findings are strongly suggestive of the disease, it may be appropriate to perform simultaneous bilateral biopsies, anticipating that the contralateral side will be needed if the first specimen is negative. In select cases, continued treatment is given despite negative biopsies based on a strong clinical suspicion of disease.…”

Section: Temporal Artery (Ta) Biopsymentioning

confidence: 99%

Neuro-Ophthalmic Emergencies for the Neurologist

Purvin¹,

Kawasaki²

2005

The Neurologist

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A variety of acute neurologic disorders present with visual signs and symptoms. In this review the authors focus on those disorders in which the clinical outcome is dependent on timely and accurate diagnosis. The first section deals with acute visual loss, specifically optic neuritis, ischemic optic neuropathy (ION), retinal artery occlusion, and homonymous hemianopia. The authors include a discussion of those clinical features that are helpful in distinguishing between inflammatory and ischemic optic nerve disease and between arteritic and nonarteritic ION. The second section concerns disc edema with an emphasis on the prevention of visual loss in patients with increased intracranial pressure. The third section deals with abnormal ocular motility, and includes orbital inflammatory disease, carotid-cavernous fistulas, painful ophthalmoplegia, conjugate gaze palsies, and neuromuscular junction disorders. The final section concerns pupillary abnormalities, with a particular emphasis on the dilated pupil and on carotid artery dissection. Throughout there are specific guidelines for the management of these disorders, and areas are highlighted in which there is ongoing controversy.

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“…Discordance, or differing biopsy results for each artery in a bilateral biopsy, has led several authors to express support for routine bilateral biopsies [40,41]. The reported discordance rate ranges from 3% to 13% [40][41][42]. Acknowledging the importance of a correct biopsy result, others support an initial unilateral biopsy in expert hands [42,43].…”

Section: Surgerymentioning

confidence: 99%

“…The reported discordance rate ranges from 3% to 13% [40][41][42]. Acknowledging the importance of a correct biopsy result, others support an initial unilateral biopsy in expert hands [42,43]. A unilateral biopsy minimizes the small but real risk of surgery, preserves an artery in the event that a diagnosis of GCA is considered in the future, and minimizes costs and physician time.…”

Section: Surgerymentioning

confidence: 99%

“…A unilateral biopsy minimizes the small but real risk of surgery, preserves an artery in the event that a diagnosis of GCA is considered in the future, and minimizes costs and physician time. A patient should be monitored closely after the unilateral biopsy, and a second biopsy should be performed if suspicion persists despite a negative unilateral biopsy [42,43]. If a patient has a negative bilateral biopsy and strong suspicion for GCA persists, that patient should be treated despite negative biopsy results.…”

Section: Surgerymentioning

confidence: 99%

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Giant cell arteritis

Hall¹,

Balcer

2004

Curr Treat Options Neurol

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Patients with a suspected diagnosis of giant cell arteritis (GCA) should be started on high-dose corticosteroid therapy without delay. A temporal artery biopsy should be performed after initiation of therapy to confirm the diagnosis. Patients with acute visual or neurologic symptoms present a neuro-ophthalmic emergency. Therapy should be initiated immediately with high-dose intravenous methylprednisolone sodium succinate and followed by high-dose oral prednisone. Treatment may begin with high-dose oral prednisone in patients without visual or neurologic symptoms. Calcium, vitamin D, and peptic ulcer prophylaxis should accompany steroid therapy, as indicated. The following treatments should be considered for patients with suspected GCA and acute visual or neurologic signs or symptoms: intravenous methylprednisolone sodium succinate (250 mg intravenously every 6 hours) should be given for 3 days, followed by oral prednisone (80 mg per day or 1 mg/kg) for 4 to 6 weeks. Prednisone should then be tapered by 10 mg per day every month. Most patients require 1 year of therapy to avoid relapse. Taper and duration should be modified according to erythrocyte sedimentation rate, C-reactive protein, and signs and symptoms of GCA. Rheumatologic consultation and follow-up is often helpful for these patients. For patients with suspected GCA and no acute visual or neurologic signs or symptoms, therapy may begin directly with oral prednisone (80 mg per day or 1 mg/kg) with same taper and duration based on laboratory values and clinical signs and symptoms.

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The role of unilateral temporal artery biopsy

Cited by 57 publications

References 7 publications

Giant Cell Arteritis

Giant Cell Arteritis

Neuro-Ophthalmic Emergencies for the Neurologist

Giant cell arteritis

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