Temporal arteritis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

Patients with temporal arteritis usually appear in pain or normal. The presence of temporal tenderness on physical examination is highly suggestive of temporal arteritis. Ophthalmoscopic exam may be abnormal with findings of sludging of blood in retinal arterioles, optic disc may show chalky white pallor and edema, with or without splinter hemorrhages, posterior ischemic (retrobulbar) optic neuropathy, central retinal artery occlusion, branch of retinal artery occlusion, and choroidal ischemia. Tenderness upon palpation of the temporal region including erythema, nodularity, and thickening on affected side. Other findings include facial tenderness, diplopia, ptosis, nystagmus, internuclear ophthalmoplegia (INO), and pupillary abnormalities.

Physical Examination

  • The presence of temporal tenderness on physical examination is highly suggestive of temporal arteritis.

Appearance of the Patient

  • Patients with temporal arteritis usually appear in pain.

Vital Signs

  • Vital signs are with in normal limits.

Skin

  • Skin examination of patients with temporal is usually normal.

HEENT

Neck

  • Neck examination of patients with temporal arteritis is usually normal.

Lungs

  • Pulmonary examination of patients with temporal arteritis is usually normal.

Heart

  • Cardiovascular examination of patients with temporal arteritis is usually normal.

Abdomen

Abdominal examination of patients with temporal arteritis is usually normal.

Back

  • Back examination of patients with temporal arteritis is usually normal.

Genitourinary

  • Genitourinary examination of patients with temporal arteritis is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with temporal arteritis is usually normal.

Extremities

  • Extremities examination of patients with temporal arteritis is usually normal.

References

  1. Saha, N; Rehman, S U (2005). "Reversal of chronic ocular ischaemia with good visual recovery in giant cell arteritis". Eye. 20 (6): 742–743. doi:10.1038/sj.eye.6701998. ISSN 0950-222X.
  2. Schäuble B, Wijman CA, Koleini B, Babikian VL (2000). "Ophthalmic artery microembolism in giant cell arteritis". J Neuroophthalmol. 20 (4): 273–5. PMID 11130757.
  3. Schmidt D (2005). "Ocular ichemia syndrome - a malignant course of giant cell arteritis". Eur J Med Res. 10 (6): 233–42. PMID 16033712.
  4. Tovilla-Canales JL (1998). "Ocular manifestations of giant cell arteritis". Curr Opin Ophthalmol. 9 (6): 73–9. PMID 10387340.
  5. Al-Abdulla NA, Kelley JS, Green WR, Miller NR (2003). "Herpes zoster vasculitis presenting as giant cell arteritis with choroidal infarction". Retina. 23 (4): 567–9. PMID 12972779.
  6. Casson RJ, Fleming FK, Shaikh A, James B (2001). "Bilateral ocular ischemic syndrome secondary to giant cell arteritis". Arch Ophthalmol. 119 (2): 306–7. PMID 11177002.
  7. Borg FA, Salter VL, Dasgupta B (2008). "Neuro-ophthalmic complications in giant cell arteritis". Curr Allergy Asthma Rep. 8 (4): 323–30. PMID 18606086.
  8. Killer HE, Holtz DJ, Kaiser HJ, Laeng RH (2000). "Diplopia, ptosis, and hepatitis as presenting signs and symptoms of giant cell arteritis". Br J Ophthalmol. 84 (11): 1319–20. PMC 1723314. PMID 11203169.
  9. Ahmad I, Zaman M (1999). "Bilateral internuclear ophthalmoplegia: an initial presenting sign of giant cell arteritis". J Am Geriatr Soc. 47 (6): 734–6. PMID 10366177.
  10. Foroozan R, Buono LM, Savino PJ, Sergott RC (2003). "Tonic pupils from giant cell arteritis". Br J Ophthalmol. 87 (4): 510–2. PMC 1771609. PMID 12642330.



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