Bilateral Temporal Artery Research Articles

Aortite thoraco-abdominale au cours d’une spondylarthrite ankylosante : un nouveau cas et revue de la littérature

We report a case of aortitis in a patient with ankylosing spondylitis revealed by an unexplained persistent inflammation. The diagnosis of ankylosing spondylitis was retained in a 64-year-old woman suffering from inflammatory back and neck pain combined with buttock pain relieved by anti-inflammatory drugs (NSAIDs) since 2004 and more recent bilateral heel pain in the morning since 2006; sacroiliitis was grade 3 on the right and grade 2 on the left (modified New-York criteria). The patient had remained asymptomatic from April 2006 to 2007 with NSAID as needed. Nevertheless, biological inflammation persisted: erythrocyte sedimentation rate 44 to 55 mm/h, activated protein C 34 to 90 mg/L. Complementary examinations are negative: bilateral temporal artery biopsy, endoscopy with duodenal biopsy looking for Tropheryma whipplei. The thoraco-abdominal and pelvic CT scan revealed aortitis extending from the abdominal aorta to the iliac axis. Treatment with prednisone 0.5 mg/kg was started to decrease the inflammatory aortitis. The most "classical" cardiovascular damage observed in spondylitis is aortic insufficiency and conduction disturbances. The first cases of aortitis were reported in 1958. Inflammatory vascular disease should be evoked as a possible diagnosis in patients with ankylosing spondylitis the presenting an unexplained biological inflammation (ESR and CRP).

CP5 She's going blind!

A 76-year-old woman woke with painless visual loss in her left eye. It was preceded by a 6-week history of headache, jaw claudication, anorexia and weight loss. Visual acuities were...

Repair of cervicofacial scar by forehead expansive skin flap double-pedicled with superficial temporal vessels

To explore the clinical efficacy of using forehead expansive skin flap double-pedicled with superficial temporal vessels for repairing male cervicofacial scar. From July 2005 to June 2009, 13 male patients with an average age of 27 years old (range: 21 - 38) were operated by the above method. The scar-repairing area was from 14 cm × 5 cm to 32 cm × 15 cm. The procedure was carried out in three stages. Firstly, ultrasound Doppler was used to detect and mark the location and orientation of superficial temporal artery. A proper cavity was created under the forehead muscle and then the appropriate expander embedded through the scalp incision. The expander was expanded first by injecting normal saline at 1 or 2 weeks post-operation. After that, the injection was repeated by 3 or 5 days. The volume ratio of injection to expander was (1.5-3.5):1. Secondly the forehead expansive skin flap was designed with proper hair follicle scalp pedicled by bilateral superficial temporal artery when the expansion was completed. After removal of the expander, the rectangle expansive skin flap with hair follicle scalp was transferred through the double pedicle. The cervicofacial scar was excised according to the size of the transferred expansive skin flap (25 cm × 6 cm to 32 cm × 9 cm). And the flap was adjusted with hair follicle scalp to the middle of the chin area in order to obtain the normal beard appearance. Donor site were closed directly. Thirdly, the pedicle skin flap were cut and restored after one month. The volume expanded for each expander ranged from 420 to 800 ml (mean: 660). The average expansion time was 4 months (range: 3 - 5). All flaps survived well. Donor site were closed directly. Both chin and beard looked normal. Repairing hypertrophic scar and reconstructing beard in cervicofacial area with forehead expansive skin flap pedicled by bilateral superficial temporal artery is a valuable and safe method. The donor site is scarless. And the reconstructed chin and beard are normal both functionally and aesthetically.

Bilateral Superficial Temporal Artery Aneurysms

Aneurysms of the superficial temporal artery are rare and most often traumatic in origin. In this case study we present an extremely rare occurrence of bilateral nontraumatic superficial temporal artery aneurysms. Spontaneous bilateral superficial temporal artery aneurysms have not been previously reported. The patient was a 49-year-old woman who presented to our outpatient vascular lab with pulsating masses noted over bilateral temporal regions. Duplex ultrasound revealed a 2.3 mm right and 4.5 mm left temporal artery aneurysm. The aneurysms were subsequently resected and the patient recovered without incident. Non-invasive duplex ultrasound is an effective method in identifying these rare aneurysms. A literature search revealed few published cases of non-traumatic STAs and of these cases none involved bilateral vessels.

Rate of Discordant Findings in Bilateral Temporal Artery Biopsy to Diagnose Giant Cell Arteritis

To determine to what extent performing simultaneous bilateral temporal artery biopsies might increase the diagnostic sensitivity in giant cell arteritis (GCA). In total 173 consecutive pathology reports of temporal artery biopsies were reviewed for histological findings by a single pathologist. The rate of discordance of biopsy results was calculated in patients with GCA. Biopsies were performed bilaterally and simultaneously in 132 cases; 51 had positive results. In 38 the biopsy was positive on both sides (concordant results), while in 13 patients only one side was positive (discordant results), reaching a discordance rate of 13/51=0.255. Therefore 12.7% of the patients (one-half of the discordance rate) could have been misdiagnosed as biopsy-negative had a biopsy been done only unilaterally in those 51 cases. These data suggest that performing bilateral temporal artery biopsies increases the diagnostic sensitivity of the procedure by up to 12.7%, compared to unilateral biopsies.

Isolated Superficial Temporal Artery Dissection Masquerading as Giant Cell Arteritis

A 79-year-old male presented with symptoms suggesting giant cell arteritis (GCA) and elevation of acute-phase reactants. Bilateral superficial temporal artery (STA) biopsies were negative for GCA. However, the right-sided biopsy showed a STA dissection. Spontaneous isolated STA dissection has never been reported previously. The pertinent available literature is also discussed.

Diagnosing temporal arteritis: duplex vs. biopsy

Temporal artery biopsy is the traditionally-accepted method of diagnosing temporal arteritis, but is of limited sensitivity. To compare the clinical decisions made after negative temporal artery biopsy vs. negative temporal artery duplex, and the effects on patient outcomes. Retrospective analysis. Of 290 patients suspected of having temporal arteritis, 147 underwent bilateral temporal artery duplex with a negative result, and 143 underwent unilateral temporal artery biopsy with a negative result. These groups were compared. Dependent measures included the proportion of patients in each group whose steroids were discontinued by their primary care doctor after either negative test, and the difference in the number of alternative diagnoses considered after a negative test. The incidence of blindness in each group was also compared, as a measure of adverse outcomes. Patients were then stratified by pre-test probability of having the disease, and compared using the same measures. Equivalent proportions of patients in the two groups had steroids discontinued after a negative test result, even when further stratified into risk groups by the probability of having temporal arteritis. No differences in adverse outcomes or number of alternative diagnoses considered were noted between groups. In clinical practice, bilateral temporal artery duplex served the same function as biopsy, but without subjecting patients to the potential morbidity of a surgical procedure. Temporal artery biopsy could be reserved only for situations where the duplex result is inconsistent with the clinical picture, and the biopsy result, if different from the duplex result, might influence the treatment decision.

Huge, alarming congenital hemangioma of the scalp presenting as heart failure and Kasabach-Merritt syndrome: a case report

We report on a neonate with a huge congenital hemangioma of the scalp presenting as high-output heart failure and Kasabach-Merritt syndrome. The condition was successfully treated by means of surgical excision. A prematurely born (gestational age=36 weeks; birth weight=2,316 g), three-day-old female infant was referred to our institution for a huge scalp tumor (Fig. 1), already detected by fetal ultrasonography at six months of gestation. Head computed tomography scan revealed a hypervascular tumor of the scalp with strong heterogeneous enhancement. Magnetic resonance imaging demonstrated multiple feeding arteries, mainly consisting of an anastomosis of bilateral superficial temporal arteries and branches of the internal carotid artery. There was no evidence of intracranial hemorrhage. The patient had early heart failure signs including progressive respiratory distress and tachycardia. A small patent ductus arteriosus was present (1.2 mm in size). Thrombocytopenia (134 10/L) on the 1st day of life progressed to the lowest level (107 10/L) on day 3. On day 4, normocytic anemia (hemoglobin=11.5 g/dL) was present, prothrombin time was prolonged (16.3 seconds) as was partial thromboplastin time (79 seconds). Direct Coombs_ test was negative and both fibrin split products (80–160 mg/ml; normal<10 mg/ml) and D-Dimer (1.94 mg/ml; normal<0.5 mg/ml) were increased. The early heart failure signs improved soon after oxygen hood. Dopamine (5 mg/kg/min) and parenteral furosemide were administered beginning on the 3rd day of life. On the 5th day of life surgical excision following ligation of the feeding arteries was successful apart from the need for a whole-blood transfusion for surgery-related blood loss of approximately 300 mL. Indirect hyperbilirubinemia on the day subsequent to surgery complicated patient recovery, followed by the need for a double-volume blood-exchange transfusion in order to deal with a total bilirubin level escalating to 23.8 mg/dL. The patient_s thrombocytopenia resolved from the 14th day of life. Dopamine and furosemide were discontinued three days following surgery and the baby was discharged in good condition two weeks later. The histological findings from the excised lesion revealed a number of vascular channels located beneath the scalp and surrounded by fibrotic and myxoid stroma. Low cellularity and scant mitotic figures were noted without any malformed vessels. Hemangioma is present in more than 10% of normal newborns with a strong female predominance [4]. Approximately 60% of the hemangiomas of infancy appear on the head and neck [3], ninety-five percent will regress spontaneously without sequelae [1]. By contrast, 3–5% of hemangiomas involve vital organs or produce life-threatening complications requiring the need for aggressive therapy [5]. The management of hemangioma is generally divided into conservative treatment and intervention therapy. A response rate to treatment of 45%, but a cure rate of only 18% has been reported following prednisone therapy (3–10 mg/kg/day) for six to eight weeks [5]. Serious side effects of interferon-a limit its use to life-threatening cases [2]. We chose direct surgical intervention for our patient, mainly Eur J Pediatr (2007) 166:619–620 DOI 10.1007/s00431-006-0278-x

Recurrent lymphocytic hypophysitis and bilateral intracavernous carotid artery occlusion. An observation and review of the literature

Objectives: Bilateral carotid artery occlusion associated with lymphocytic hypophysitis is exceedingly rare. We describe this association and review the literature.Methods: The authors describe a 38-year-old woman with a history of severe headaches. Magnetic resonance (MR) imaging showed an intrasellar mass with invasion of both cavernous sinuses. Lymphocytic hypophysitis was diagnosed by transphenoidal biopsy. In the course of the disease, she developed symptoms of cerebral ischemia attributable to bilateral occlusion of her internal carotid arteries in both cavernous sinuses. She underwent bilateral superficial temporal artery-middle cerebral artery bypass surgery.Results: The patient experienced progressive neurological recovery after surgery. A literature search revealed no other cases describing this unique association.Conclusions: Bilateral carotid artery occlusion may develop in the course of lymphocytic hypophysitis with cavernous sinus involvement. If indicated, cerebral revascularization should be performed to reverse cerebral ischemia.

Herpes zoster ophthalmicus: presenting as giant‐cell arteritis

A 74-year-old woman was referred to the authors' clinic with a 1-week suspicion of giant-cell arteritis. Uncomplicated, bilateral temporal artery biopsies were performed 3 days after admission for therapy. Four hours after the procedure she developed vesicular lesions of the face compatible with herpes zoster ophthalmicus. The temporal artery biopsy revealed perineural lymphocytic aggregation. Both giant-cell arteritis and herpes zoster ophthalmicus form part of the differential diagnosis in elderly patients with headache. In such cases, clues from a temporal artery biopsy may aid in diagnosis of herpes zoster. In addition, the patient in this case developed the rash 10 days after onset of symptoms, which is rare as the average time from onset of symptoms to rash in zoster is 3-5 days.

Low diagnostic yield with second biopsies in suspected giant cell arteritis.

The clinical diagnosis of giant cell arteritis may be confirmed with a biopsy of the superficial temporal artery. Because of "skip lesions," a histologic diagnosis of giant cell arteritis may be missed with a unilateral biopsy. The authors report a study that investigates whether a biopsy of the contralateral superficial temporal artery provides any additional information for confirmation of a diagnosis of giant cell arteritis. Available medical records of 91 consecutive patients who underwent bilateral superficial temporal artery biopsy procedures were reviewed. Information that was abstracted included sequence of biopsy procedures, length specimens, and histologic diagnosis. Microslides from all biopsy specimens were retrieved and reexamined in a masked fashion by the ocular pathologist (RCE) who had made the original diagnoses. Seventy-two bilateral simultaneous superficial temporal artery biopsies and 19 bilateral sequential biopsies were performed. The mean length of biopsy specimens was 23 mm, and the mean length of the total artery removed from each patient was 33 mm. The pathologist's original diagnosis and the diagnosis at reexamination were in 100% agreement. In 90 (99%) of the 91 patients, the histologic diagnoses in the left and right superficial temporal arteries were the same. This is a concordance rate of 98.9% (38 of 39 positive biopsy results) among the positive biopsy results. There is a low yield of information from a second temporal artery biopsy in patients with suspected giant cell arteritis. This suggests that patients who present to the ophthalmologist with possible giant cell arteritis will, in most cases, have a similar diagnosis on both temporal artery biopsies if the specimens are adequate.

Concordance of bilateral temporal artery biopsy in giant cell arteritis.

To determine whether the diagnostic sensitivity of bilateral temporal artery biopsy is superior to that of unilateral biopsy in cases of suspected temporal arteritis. A retrospective analysis of the results of 60 bilateral temporal artery biopsies examined in an ophthalmic pathology laboratory. The histopathologic diagnosis in 13% of the biopsy pairs was discordant. There was a 5% chance of obtaining a positive biopsy result on the side opposite an initially negative biopsy result. Bilateral temporal artery biopsy is 5% more likely than unilateral biopsy to detect the characteristic histopathologic findings in patients with temporal arteritis.

Efficacy of unilateral versus bilateral temporal artery biopsies for the diagnosis of giant cell arteritis

PURPOSE: To determine the utility of unilateral versus bilateral temporal artery biopsies in detecting the pathologic changes of giant cell arteritis. METHODS: We performed a retrospective study to determine the utility of unilateral versus bilateral temporal artery biopsies in detecting the pathologic changes of giant cell arteritis. The pathologic reports of consecutive temporal artery biopsy specimens received at the Wilmer Ocular Pathology Laboratory over a 28-year period from 1968 to 1996 were reviewed. RESULTS: Of 908 specimens examined from 758 patients, 300 specimens were simultaneous bilateral biopsies from 150 patients, 72 specimens were bilateral sequential biopsies from 36 patients, and the remaining 536 specimens were unilateral biopsies from 536 patients. Of the 186 patients who had bilateral simultaneous or nonsimultaneous biopsies, 176 had identical diagnoses on both sides. In four patients, no artery was obtained on one side. In each of the remaining six patients, five of whom had bilateral simultaneous biopsies and one of whom had bilateral sequential biopsies performed 8 days apart, the biopsy specimen from one side was interpreted as showing only arteriosclerotic changes with no evidence of active or healed arteritis, whereas the other specimen was interpreted as showing either probable healed arteritis (three specimens) or possible early arteritis (three cases). In none of the six patients with differing diagnoses between the two sides was one side interpreted as showing definite, active giant cell arteritis. Five of the six patients were subsequently determined to have giant cell arteritis, based on a combination of clinical findings, erythrocyte sedimentation rate, and response to treatment with systemic corticosteroids. CONCLUSIONS: The results of this study indicate that performing a bilateral simultaneous or sequential temporal artery biopsy improves the diagnostic yield in at least 3% of cases of giant cell arteritis, whereas in 97% of cases, the two specimens show the same findings. Thus, in patients in whom only one artery can be biopsied, there is a high probability of obtaining the correct diagnosis. Nevertheless, although the improvement in diagnostic yield of bilateral temporal artery biopsies is low, the consequences of both delayed diagnosis and treatment of giant cell arteritis as well as the use of systemic corticosteroids in patients who do not have giant cell arteritis are of such potential severity that consideration should always be given to performing bilateral temporal artery biopsies in patients suspected of having the disease.

Giant Cell Arteritis.

Diagnosis and management of giant cell (temporal) arteritis (GCA) should be performed by physicians who can accurately monitor the ophthalmologic, neurologic, and systemic sequelae of the disease as well as the numerous side effects of systemic corticosteroids, which are typically necessary for treatment. When the diagnosis of giant cell arteritis is seriously entertained, early treatment with adequate doses of oral or intravenous corticosteroids should not be delayed until laboratory confirmation has been obtained. Unilateral or bilateral temporal artery biopsy should be performed on all patients with suspected GCA. A positive biopsy result mandates that higher doses of corticosteroids be used during the first 2 months, which comprise the critical period for risk of new ocular ischemia. A definitive, biopsy-proven diagnosis requires at least 6 months, and typically 12 months, of corticosteroid therapy. Common pitfalls include increasing the dose and prolonging the use of corticosteroids in response to increases in the erythrocyte sedimentation rate (ESR) unrelated to GCA or visual blurring that may be related to benign tear film abnormalities, corticosteroid-induced lens changes, and other ophthalmic conditions. The muscle stiffness of polymyalgia rheumatica (PMR) must be distinguished from the osteoarthritis and other painful conditions common in the elderly. After corticosteroid therapy has begun, continuing ophthalmologic evaluation is necessary to evaluate the effectiveness of treatment and whether ocular complications, such as glaucoma or cataract, develop. Careful attention must be given to early detection and prevention of systemic side effects of corticosteroid treatment. Patients may be given gastrointestinal protective agents, such as histamine (H(2))-blocking agents; vitamin D and calcium; oral hypoglycemic agents; and, if necessary, insulin and antihypertensive drugs. If bone density measurements warrant, hormones/supplementation to prevent or reverse osteoporosis may be prescribed. After the initial diagnosis and first 4 weeks of treatment, elevation of the ESR or C-reactive protein alone should generally not be used as signs of disease activity nor as a reason to increase the daily dose of steroids. If symptoms or signs of disease activity occur, the dose should be raised regardless of test results. Even with vigorous physician-patient education, however, a patient is occasionally unable to provide adequate historical information about response to therapy, and the physician is forced to rely on laboratory values as a measure of disease activity. After initial high-dose corticosteroid therapy, patients without a classic history and with negative biopsy results will generally receive a rapid taper to low doses of corticosteroids. The role of repeated temporal artery biopsy in the clinical management of GCA is unclear. Despite persistence of PMR and, in some cases, histologic evidence of inflammation in temporal arteries, patients do not frequently have recurrence of symptomatic GCA after 6 months or more of corticosteroid therapy. Under these circumstances, late vision loss is rare.

Reconstruction of damaged forehead with bilateral fasciocutaneous temporal V–Y-advancement island flaps

SUMMARY.Multiple contusions and lacerations of the anterior two-thirds of the forehead were treated by resection of the damaged skin and immediate reconstruction of the forehead with bilateral temporal artery fasciocutaneous advancement flaps.

Multi-Vessel Biopsy-Proven Giant Cell Arteritis Involving the Occipital and Temporal Arteries

Occipital neuralgia is a commonly encountered presenting feature in patients with giant cell arteritis. However, actual histopathologic confirmation of vasculitis of the occipital arteries is rarely cited. We present the first case of multi-vessel giant cell arteritis diagnosed with simultaneous biopsies of the right occipital and bilateral temporal arteries, along with a discussion concerning a possible role for occipital artery biopsies in the evaluation of giant cell arteritis.

Rapid and Near-Complete Resolution of Moyamoya Vessels in a Patient with Moyamoya Disease Treated with Superficial Temporal Artery-Middle Cerebral Artery Bypass

Several groups have reported partial resolution of moyamoya vessels following surgical revascularization in pediatric patients, but angiographic documentation of near-complete resolution has been poor. We report here a case of a 5-year-old boy who underwent bilateral superficial temporal artery-middle cerebral artery bypass combined with unilateral encephaloduroarteriosynangiosis who demonstrated near-complete resolution of moyamoya vessels and a dramatic improvement in cerebral perfusion as measured by xenon-enhanced CT. The resolution of moyamoya networks may serve as an indicator of successful surgical revascularization.

Cytokines in Polymyalgia and Giant Cell Arteritis

Letters15 April 1995Cytokines in Polymyalgia and Giant Cell ArteritisLarry M. GreenbaumLarry M. GreenbaumSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-122-8-199504150-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Weyand and colleagues [1] found that patients with polymyalgia rheumatica and giant cell arteritis have similar cytokine profiles. However, their patients with polymyalgia rheumatica may not be representative of most of these patients. Seventeen tissue samples from 9 different patients were available for analysis. It is unclear whether 17 different temporal artery biopsy specimens were taken from 9 patients or whether different fragments of the same biopsy specimen were analyzed separately for some patients. In most patients with polymyalgia rheumatica, bilateral temporal artery biopsy specimens are not usually analyzed. I wonder whether this group of patients with ...REFERENCE1. Weyand CM, Hicok KC, Hunder GG, Goronzy JJ. Tissue cytokine patterns in patients with polymyalgia rheumatica and giant cell arteritis. Ann Intern Med. 1994; 121:484-91. Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 April 1995Volume 122, Issue 8Page: 634KeywordsArteriesBiopsyCytokinesGiant cellsPatient advocacyPolymyalgia rheumatica Issue Published: 15 April 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Comparison of on-site and in-situ techniques for bioremediation of hydrocarbon polluted soils

Arteriovenous malformation of the scalp (sAVM) is a rare pathology that accounts for 8% of all cranial arteriovenous malformations. It is believed to be congenital; however, few reported were secondary to trauma. They are managed either via surgical resection, endovascular embolization, or combined approach. Cases with bilateral dual extracranial feeders are yet significantly scarce incidents among this rare pathology. We report a case of sAVM with dual bilateral feeders and review the literature.We report a case of a 24-year-old male who presented with a spontaneous para-midline enlarging mass over five years associated with headache. Imaging, including angiography, showed a subcutaneous vascular lesion measuring 2.4x4.2 cm supplied by bilateral superficial temporal arteries and occipital arteries. The patient underwent endovascular subtotal embolization with subsequent surgical excision with excellent recovery.The rare occurrence of sAVMs requires a high index of suspicion and angiographic images to assess blood supply for preoperative embolization. A combined management approach is associated with good outcome and decrease the risk of recurrence.

Dolichoectatic Basilar Artery Treated by Reducing Hemodynamic Stress

Two cases of dolichoectatic basilar artery with a mass effect to the brainstem structure were treated by reducing hemodynamic stress. In one case, angiograms showed the dolichoectatic basilar artery creating a turbulent flow in the vertebrobasilar junction, and unilateral vertebral artery clipping in addition to posterior fossa decompression was performed. The other case, a combination with bilateral internal carotid artery occlusion, underwent bilateral superficial temporal artery-middle cerebral artery anastomoses. The possible surgical treatments of dolichoectasia are discussed.