Topic: Temporal Arteritis
Subject: Medicine
A 75-year-old female presents with a 2-month history of bilateral headache, diffuse myalgias, and diplopia. On examination she has substantially diminished vision in her left eye, but no other neurologic findings. A moderately tender, cordlike structure is palpable just anterior to her ear and extending up to her lateral scalp. Blood tests show a markedly elevated erythrocyte sedimentation rate.
Which one of the following would be most appropriate at this point?

Question

Topic: Temporal Arteritis
Subject: Medicine
A 75-year-old female presents with a 2-month history of bilateral headache, diffuse myalgias, and diplopia. On examination she has substantially diminished vision in her left eye, but no other neurologic findings. A moderately tender, cordlike structure is palpable just anterior to her ear and extending up to her lateral scalp. Blood tests show a markedly elevated erythrocyte sedimentation rate.
Which one of the following would be most appropriate at this point?

A. Clopidogrel (Plavix)

B. High-dose corticosteroids

C. NSAIDs

D. Dipyridamole/aspirin (Aggrenox)

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The clinical findings in this patient are consistent with temporal arteritis: age over 50, new-onset headache, abnormalities of the temporal artery, and an elevated erythrocyte sedimentation rate. A temporal artery biopsy is needed to confirm the diagnosis, but when the findings are this compelling, corticosteroids should be started even before a biopsy, to prevent further vision loss. Temporal arteritis is the most common clinical pattern of giant cell arteritis, which can also involve other branches of the carotid artery.

Accepted Answer

B. High-dose corticosteroids

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