巨细胞颞动脉炎误诊1例报道

病　　例陈志华 ,男 ,6 3岁 ,湖南省天心实业总公司退休干部。住院号 4 344 78。因剧烈头痛 ,左上睑下垂 2月余 ,左眼失明 1周 ,于 2 0 0 1- 10 - 18第二次住院。患者自 2 0 0 1- 0 7- 16开始 ,无明显原因出现剧烈的持续性疼痛 ,以左侧为甚 ,左眼胀痛 ,1周后右眼胀痛 ,双眼视力     

颞动脉炎一例

1病例简介患者男性,85岁,因"突发性头痛5d"于2006年6月20日到急诊室就诊。患者头痛呈现间歇性,有中度搏动感,以前额为剧,没有加剧或减轻的诱发因素。既往无类似病史。无畏光、恶心、呕吐、视觉障碍、恶寒发热,无咬合关节痛及颞部痛,无近端肌力减弱、     

巨细胞动脉炎跳跃区域的超微结构特征及其意义

目的　研究巨细胞动脉炎 (GCA)颞动脉活检跳跃区域的超微结构特征及其意义。方法　对 2 0例GCA和 7例非GCA患者进行一侧颞动脉活检 ,根据光镜观察的结果 ,将GCA患者分为跳跃区域组 (14例 )和活跃期血管炎组 (6例 ) ;电镜观察 3组患者的血管超微结构 ,病理改变按 0～ 3分 4级评分。结果　超微结构的病理变化得分为 :GCA跳跃区域组 0分 1例 ,2～ 6分 9例 ,8～ 9分 4例 ;GCA活跃期血管炎组 7～ 15分 6例 ;非GCA组 0～ 1分 6例 ,5分 1例。经H检验 ,3组间差异有显著性 (P <0 0 1) ;两两比较发现 ,GCA跳跃区域组得分明显高于非GCA组 ,但低于GCA活跃期血管炎组得分。GCA跳跃区域组 ,其内膜超微结构变化突出 ,与GCA活跃期血管炎组比 ,差异无显著性 (P >0 0 5 )。结论　GCA颞动脉跳跃区域内有明显的病理改变 ,尤其是内膜。提示GCA跳跃区域超微结构的研究有助于GCA的诊断和治疗。     

误诊为糖尿病性神经病变的颞动脉炎1例报告

患者,男,61岁.于4月前无明显诱因感右颞部疼痛,以太阳穴处为重,疼痛呈持续性,阵发性加重,继而出现视物不清,入当地医院诊治.既往糖尿病病史12年,规律用药,血糖波动于10～12mmol/L.当地医院诊为糖尿病视神经病变,给予控制血糖,改善微循环,抗凝治疗,病情进一步加重.3天后,右眼视力丧失;7天后,右眼眼睑下垂,眼球固定,当地医院再次诊为糖尿病眼肌麻痹,除继续原治疗方案,加用针灸等康复治疗.住院1个月,右眼视力仍为0,右眼除外展受限外,余各方向活动灵活.患者出院后,继续服药控制血糖.4天前,患者劳累后再次出现左颞部疼痛,性质同前,急来我院.入院查体:体温36.5℃,脉博72次/分,呼吸18次/分,血压16/11kPa;神智清,言语流利,右颞浅动脉搏动减弱,右眼无光感,右眼外展受限,余各方向活动灵活.右眼瞳孔直径4mm,直接对光反应消失,间接对光反应存在;左眼瞳孔直径3 mm,直接、间接对光反应均存在.左眼视力10cm数指.眼底视乳头边清,颜色略淡,动静脉比例为1∶2,未见出血点,余神经科查体未见异常.     

颞动脉炎47例临床资料分析

目的总结颞动脉炎的临床特征及病理改变。方法收集国内报告的44例及本院治疗的3例。共47例(其中29例进行活检)资料进行分析。结果头痛46例(97.9%);视力障碍12例(25.5%);低热(6/14,42.9%);脑神经麻痹13例(27.7%),其中动眼神经8例、外展神经2例、面神经2例、听神经1例;合并风湿性多肌痛6例;合并脑梗死5例、脑出血2例。血沉80.6%(29/36)增快,C反-应蛋白71.4%(5/7)增高。颞动脉均增粗、变硬。颞动脉活检29例,28例证实为颞动脉炎。皮质内固醇治疗效果良好。结论颞动脉炎临床并不十分罕见,掌握其临床特征,多可诊断。颞动脉活检可确诊,皮质类固醇治疗效果良好。     

巨细胞动脉炎

巨细胞动脉炎（giant cell arteritis，GCA）是一种血管炎，几乎全身血管均可受累，主要侵犯弹力膜发育良好的大、中动脉，造成类似肉芽肿样炎症和全层动脉炎。1890年由Hutchinon首次对该病进行了报道。本病曾被认为是一种罕见病，其临床表现极为复杂，如不及时诊断，延误治疗可导致永久性视力丧失和脑卒中等严重并发症。但随着人们认识的不断深入，发现该病并不少见。     

颞动脉炎引起头痛5例临床分析

颞动脉炎是一种亚急性起病的动脉炎。国内报道较少 ,本院从 1986年～2 0 0 0年共收治住院颞动脉炎引起的头痛患者 5例 ,现报道如下 :1　临床资料5例患者中 ,其中男 2例 ,女 3例。年龄 42～ 81岁 ,平均年龄 6 2岁。 5例均因头痛或颞部持续性跳痛 ,阵发性加重就诊。病程 1月～ 1年均有日轻夜重和难以入睡的特点。无恶心、呕吐。伴耳鸣 1例 ,复视 1例 ,低热 2例 ,四肢无力、消瘦 3例。 5例均先后服用麦角胺咖啡因、强痛定、颅通定片等一般消炎镇痛药无效。体格检查 :体温 2例正常 ,3例有低热 (37.5～ 38℃ )。血压均正常 ,均存在单侧颞浅动脉压…     

巨细胞动脉炎并发眼肌瘫痪(附2例报告)

目的:研究巨细胞动脉炎并发眼肌瘫痪的临床特点及其鉴别诊断。方法:对2年间诊治的巨细胞动脉炎并发眼肌瘫痪的2例患者观察其临床表现、颞动脉活检的病理改变及头颅MRI扫描。结果:2例均表现为一侧头痛、复视和上睑下垂,1例伴眼球内收和上下运动受限;血沉和MRI正常;颞动脉活检显示动脉壁炎性细胞浸润;类固醇激素治疗有效。结论:了解巨细胞动脉炎并发眼肌瘫痪的临床特点至关重要,因其极易与Tolosa-Hunt综合征、动脉瘤等疾病相混。     

巨细胞动脉炎并发脑卒中一例报告

我们自 1997年 7月至 2 0 0 1年 6月共诊治巨细胞动脉炎2 1例 ,其中有 3例并发脑卒中 ,现报道 1例如下。患者女 ,5 1岁。因头痛、间歇性发热、全身肌肉痛 2周来我院门诊。发病以来即按“感冒”和“感染性疾病”治疗无效。体格检查 :Ｔ 38 3℃ ,血压 12 0 / 80ｍｍＨｇ(1ｍｍＨｇ =0 133ｋＰａ) ,右颞浅动脉前支搏动消失 ,双肺呼吸音粗。血常规 :白细胞 13 3× 10 9/Ｌ ;肌酶正常 ;血沉为 6 7ｍｍ/ｈ ;Ｃ 反应蛋白为2 0 7ｍｇ/Ｌ ;胸部Ｘ线检查正常。头部ＣＴ报告 :右顶叶皮质下小片状低密度灶 ,考虑为脑梗死。右颞浅动脉活检 :ＨＥ染色显示…     

烟雾病颈内、外动脉造影和超微病理学研究——Ⅰ.烟雾病颞浅动脉与脑膜中动脉的电镜与光镜观察

用光镜和电镜观察了13例烟雾病人中的12例颞浅A和6例脑膜中A,其主要病变是:内膜平滑肌细胞增生,内膜增厚,中膜和内膜肌细胞破坏,浓缩的细胞器散在于肌细胞间和内弹力板内外侧间质,内弹力板断裂。这些变化与烟雾病颈内动脉末端的病变相同,与炎性血管病、动脉粥样硬化不同,是烟雾病固有的病变。烟雾病不仅是脑血管病,颈外A系统亦可受累。     

Temporal arteritis: a decision-analytic approach to temporal artery biopsy

The clinical indications for temporal artery biopsy were explored using clinical decision analysis. The analysis indicated that biopsy is most useful in patients with a high likelihood of steroid side effects. It is nearly always useful when the pre-biopsy likelihood of temporal arteritis is low, but loses its value when temporal arteritis is likely on clinical grounds, except when there is a very high probability of steroid side effects. With the low biopsy sensitivity likely to exist in most institutions, the value of biopsy falls off particularly steeply with rising clinical likelihood of temporal arteritis.     

Giant cell arteritis (temporal arteritis): A report of four cases from north east India

Giant cell arteritis (GCA) is a common disease of the geriatric age group in the western world, with a prevalence of 0.2% in the fifty plus age group. It is an important cause of morbidity, with irreversible visual loss being the most ominous complication. This diagnosis is an important consideration in all cases of new onset headache in elderly subjects. Reports of giant cell arteritis are few and far between in the Indian subcontinent. In this report, we describe the clinical details of four cases of giant cell arteritis, detected at Guwahati, Assam. The four patients were in the 70-82 age group. Sex distribution was equal. All of them had polymyalgia rheumatica (PMR), with one case displaying an initial presentation as only PMR. Cardinal manifestation was a severe headache, frequently accompanied by scalp allodynia and abnormalities of the superficial temporal artery (STA) on examination. STA biopsy yielded histopathological confirmation in three patients. Permanent visual loss was noted in one patient. These cases highlight the importance of assessing the possibility of giant cell arteritis through appropriate clinical history, estimation of acute phase reactants and the judicious use of superficial temporal artery biopsy, to clinch the diagnosis.     

Giant cell arteritis (cranial arteritis,polymyalgia rheumatica)

Summary Giant cell arteritis, which is probably due to disturbed immune mechanisms, has a spectrum of clinical symptoms in elderly people. In nearly all cases such general signs as loss of appetite, loss of weight and fever are present. The sedimentation rate is almost without exception about 100 mm in the first hour. The two most frequent and typical clinical syndromes are polymyalgia rheumatica and cranial arteritis. The polymyalgia rheumatica is characterized by periarticular pain which is mostly symmetrical and accentuated in the shoulder girdle. Increasingly severe temporal headache and ocular disturbances are found with cranial arteritis in more than 50% of cases. A combination of both diseases is frequent. Other arterial branches are rarely involved. The course of the disease is over a period of 1 1/2 to 2 years. Treatment with corticosteroids is indicated mainly because of the severe ocular complications with blindness. It should begin immediately, be intensive and last over a long period. Regular followup is necessary over several years in order to avoid relapses.

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Zusammenfassung Die Riesenzellarteriitiden können sich — wohl als Ausdruck gestörter Immunmechanismen — durch ein Spektrum klinischer Symptome bei älteren Leuten manifestieren. Fast immer sind ein gestörter Allgemeinzustand, Anorexie, Abmagerung und Fieber vorhanden. Die Blutsenkungsreaktion ist so gut wie ausnahmslos sehr stark, meist auf Werte um 100 mm in der 1. Stunde, beschleunigt. Die zwei häufigsten und markantesten Symptomengruppen sind die Polymyalgia rheumatica und die Arteriitis cranialis. Die Polymyalgia rheumatica ist durch meist symmetrische, stammnahe, paraartikuläre Schmerzen, vorwiegend im Schultergürtelbereich, gekennzeichnet. Die Arteriitis cranialis ist durch oft temporale, zunehmend intensive Dauerkopfschmerzen und vor allem durch Sehstörungen in mehr als der Hälfte der Fälle charakterisiert. Ein kombiniertes Vorkommen von Polymyalgia rheumatica und Arteriitis cranialis ist häufig. Der Befall anderer Gefäßbezirke ist seltener, kann aber dann auch zu Durchblutungsstörungen des zentralen Nervensystems und der Extremitäten führen. Der spontane Krankheitsverlauf dauert 1 1/2–2 Jahre. Eine Therapie mit Corticosteroiden ist besonders wegen der schwerwiegenden oculären Komplikationen mit Erblindung indiziert. Die Behandlung muß sofort, intensiv und langdauernd sein, die Kontrollen im Hinblick auf Rezidive müssen sich über mehrere Jahre erstrecken.

     

Intracranial giant cell arteritis

Summary A case of giant cell arteritis of intracranial vessels diagnosed by autopsy is described. Giant cell arteritis of the proximal basal brain arteries was exceptionally marked in a man of 60 years. The clinical course, laboratory findings and the pathological alterations of the brain and intracranial blood vessels are described. The case is discussed on the basis of the literature on giant cell arteritis with cerebral symptoms as well as on granulomatous giant cells arteritis of the brain. A separation of these two entities does not seem justified.

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Zusammenfassung Es wird ein Fall von Riesenzellarteriitis der intrakraniellen Gefäße beschrieben, welcher bei der Autopsie diagnostiziert wurde. Bei diesem 60jährigen Mann war der histologische Befund der Riesenzellarteriitis in den proximalen Abschnitten der Gefäße der Gehirnbasis ungewöhnlich ausgeprägt. Es werden der klinische Verlauf, die Laboratoriumsbefunde und die histologischen Veränderungen des Gehirnes und der basalen Hirngefäße beschrieben. Der Fall wird anhand der Literatur über Riesenzellarteriitis mit zerebralen Symptomen diskutiert unter Einbezug der Fälle über granulomatöse Riesenzellarteriitis des Gehirnes. Eine Trennung dieser beiden Krankheitsbilder erscheint den Autoren nicht berechtigt.

     

Giant cell arteritis and normal pressure hydrocephalus. A case report

The first known case of association of giant cell arteritis and normal pressure hydrocephalus is described. The arteritis was cured with corticosteroid therapy while hydrocephalus required ventriculo-peritoneal shunt. The high protein content of cerebrospinal fluid of this patient is probably the pathogenetic mechanism of cerebrospinal fluid block, leading to occult obstructive hydrocephalus.

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Sommario Descriviamo il primo caso noto di associazione di arterite a cellule giganti ed idrocefalo a pressione normale: la prima regredì con terapia cortisonica, il secondo rese necessario una derivazione liquorale. È probabile che la modificazione della componente proteica liquorale sia in questa paziente il movente patogenetico dell'instaurarsi di un idrocefalo ostruttivo occulto.

     

Ruptured vertebrobasilar aneurysm associated with giant cell arteritis in a young boy

Intracranial aneurysms are rare in early childhood and there is little published information on their histology. We report a young boy who died of subarachnoid haemorrhage, 29 months after coiling of a giant vertebrobasilar aneurysm. Histology of the aneurysm revealed intramural inflammation with giant cells and fragmentation of the internal elastic lamina. The findings highlight the need for detailed examination in such cases, to elucidate the pathogenesis and pathology of cerebrovascular aneurysms in this age group.     

Arteritis temporal e ictus: análisis de 6 casos

IntroductionThough uncommon, ischaemic stroke due to temporal arteritis carries serious difficulties for diagnosis and subsequent management and requires a high level of suspicion.MethodsWe analysed a series of 6 patients with biopsy-proven temporal arteritis presenting with ischaemic stroke. We discuss clinical characteristics, difficulties of assessment, short- and long-term progression, treatment, and the usefulness of new diagnostic techniques.ResultsOur sample of 6 patients had a mean age of 68.3 years; 50% were women. The majority of patients showed systemic symptoms. Anterior and posterior circulation were affected similarly. MRI angiography, Doppler sonography, and PET-CT proved to be very useful for diagnosis and treatment. Mean follow-up time was 26 months. Clinical outcomes were far from good: 33% scored ≥ 3 on the modified Rankin scale, including one death. Two patients had recurrent stroke despite treatment with full doses of corticosteroids, and 2 underwent angioplasty.ConclusionsStroke caused by giant cell arteritis is a serious and potentially severe condition which requires a high level of suspicion and early treatment with corticosteroids. New diagnostic techniques contribute to refining patient assessment and identifying the optimal treatment. Endovascular treatment may be a valid therapeutic option in selected patients.     

Giant cell tumor of the temporal bone with intratumoral hemorrhage

We report a case of hemorrhagic giant cell tumor (GCT) of the temporal bone in a 77-year-old woman. The patient suffered from sudden-onset headache and vomiting associated with left temporal hemorrhage. MRI revealed a left temporal extradural mass lesion expanding to the subtemporal fossa, showing strong hypointensity on T(2)-weighted imaging. Subsequent MRI revealed tumor growth with multiple cystic components at 1-month follow up. The tumor was found to be a GCT associated with recent intratumoral hemorrhage and abundant hemosiderin pigmentation. T(2)-weighted MRI of the GCT strongly supported hemosiderin deposition. Secondary formation of cystic components in the GCT can also reflect prior hemorrhage and indicate the progression of shape modification. A literature review revealed that hemosiderin deposition in this rare entity is not as rare as previously thought and that massive intratumoral hemorrhage may occur.