An elderly female presents with the features of fever, headache, diplopia. Biopsy of the aery revealed panaeritis. What is the most probable diagnosis
Correct Answer: Temporal aeritis
Description: Temporal aeritis is also known as Giant cell aeritis (GCA) . It is a granulomatous aeritis that affects any large (including aoa) and medium-sized aeries. It is commonly associated with polymyalgia rheumatica (PMR), which presents with symmetrical, immobility-associated neck and shoulder girdle pain and stiffness. The average age at onset is 70, with a female-to-male ratio of about 3 : 1. The overall prevalence is about 20 per 100 000 in those over the age of 50 years. Clinical features The cardinal symptom of GCA is headache, which is often localised to the temporal or occipital region and may be accompanied by scalp tenderness. Jaw pain develops in some patients, brought on by chewing or talking. Visual disturbance can occur (most specifically amaurosis) and a catastrophic presentation is with blindness in one eye due to occlusion of the posterior ciliary aery. On fundoscopy, the optic disc may appear pale and swollen with haemorrhages, but these changes may take 24-36 hours to develop and the fundi may initially appear normal. Rarely, neurological involvement may occur, with transient ischaemic attacks, brainstem infarcts and hemiparesis. In GCA, constitutional symptoms, such as weight loss, fatigue, malaise and night sweats, are common. With PMR, there may be stiffness and painful restriction of active shoulder movements on waking. Muscles are not otherwise tender, and weakness and muscle-wasting are absent . Ref Davidsons 23e p1042
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