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…     

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、     

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.     

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     

巨细胞动脉炎:颞动脉活检光镜研究

目的 探讨中国人巨细胞动脉炎(GCA)颞动脉活检的病理学特征和意义。方法 诊断为GCA的患者20例，非GCA患者7例为对照；以临床症状、颞动脉活检、类固醇激素治疗及随访结果作为诊断标准。结果 20例患者被诊为GCA，其中16例符合美国风湿病学会(ACR)的GCA诊断标准，18例显示活跃期血管炎，14例显示跳跃性损害，灵敏度、特异度和阳性预告值分别为90．0％、83．3％～94．8％。结论 提示颞动脉活检对GCA的诊断和治疗都具有重要意义。     

以周围神经病为首发症状的6例结节性多动脉炎的临床病理特点

目的回顾性分析6例以周围神经病为首发症状的结节性多动脉炎(PAN)患者的临床和病理特点,为早期诊断提供帮助。方法总结分析6例PAN患者的临床特点,作为首发症状的周围神经病的起病方式,进展过程,症状与体征的演变,以及电生理检查与腓肠神经组织病理学特点。同时总结6例患者的其他伴随症状,血液学检查,血管超声等检查手段的诊断意义。结果6例患者多数起病较急,下肢受累早,且症状比上肢重。感觉神经受累出现早,且刺激性症状比较突出。症状与体征不对称,尤其在病程早期更明显,后期可表现为远端对称或不对称性的多发性周围神经病。本组患者神经传导以波幅下降为主,感觉和运动神经均受累。3例患者行腓肠神经活检术,仅1例患者发现血管炎的典型病理改变。结论结节性多动脉炎以周围神经病为首发症状时诊断较困难。应详细询问病史,仔细查体。实验室检查如血沉快,C反应蛋白升高,血白细胞增多,血管彩超发现小动脉瘤或血管狭窄等具有提示意义。电生理检查可明确神经病变的部位和程度,神经和肌肉活检可证实诊断。     

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。     

14例脑动脉炎的临床表现及病因分析

<正> 临床资料 14例均经脑组织活检病理诊断、脑脊液PCR检测及脑电图和头颅CT扫描。其中,男性5人,女性9人。年龄最小者5岁,最大者42岁,平均21岁。以单纯癫痫起病者3例,均为感染性动脉炎,有发热、头痛、乏力伴癫痫发作起病者3例,其中2例感染性动脉炎,1例非感染性动脉炎。另外,以发热、肢瘫起病者2例。以发热、反复脑梗塞起病者4例。细菌性痢疾中突发肢瘫者1例。系统性红斑狼疮中枢瘫者1例。这些均为非感染性动脉炎。6例感染性动脉炎中3例为猪囊虫性动脉炎,2例为弓形体动脉炎,1例结核性动脉炎。其脑血管损害部位特点为:猪囊虫性动脉炎常损害额顶叶皮层区小动脉。弓形体多损害脑深部白质区小动脉。结核性多损害前后穿支动脉。8例非感染性动脉炎,大动脉炎2例,经造影证实。风     

钩端螺旋体L型脑动脉炎44例临床分析

目的:研究钩端螺旋体L型脑动脉炎发病机制,诊断及治疗:方法:对患者做钩体MAT检测,钩体L型培养,头颅CT扫描,结合文献分析总结。结果:本病多发生青少年,有钩体感染史,出现脑血管病变体征,其中偏瘫型25例,双偏瘫型8例,其它类11例。血和CSF钩体MAT(+)分别是87.5％(35/40)和72％(18/25)钩体L型培养(+)59.5％(44/74)。头颅CT显示梗塞灶27例,出血灶2例。青霉素等药治疗有效。结论:本病的发生可能与钩体L型直接损伤脑血管密切相关,根据病史,体征,钩体L型培养,头颅CT扫描进行诊断和鉴别诊断。青霉素、甲哨哒唑治疗可改善病情。     

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.

     

Temporal arteritis presenting as an extrapyramidal disorder

A case of temporal arteritis presenting with extrapyramidal symptoms (tremor, rigidity and extrapyramidal hypertonus) unresponsive to conventional treatment is here described. The onset of headache and laboratory abnormalities suggestive of temporal arteritis prompted a temporal artery biopsy which confirmed the diagnosis; the administration of corticosteroids led to the resolution of all symptoms.     

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.     

Temporal arteritis: A case series from south India and an update of the Indian scenario

Objective:

To study the clinical, pathological and prognostic profile of patients with temporal arteritis in India.

Materials and Methods:

The study was conducted in a tertiary care center from south India from 2005 to 2010 in the departments of neurology and medicine. The details of all patients that satisfied the ACR 1990 criteria for diagnosis of temporal arteritis were reviewed. The clinical presentation, laboratory parameters and biopsy findings of the patients were analyzed and compared with other studies from India done over the last decade.

Results:

A total of 15 patients were diagnosed with temporal arteritis. The male:female ratio was 1.5:1. The mean age of onset was 67.58 years. Mean time for detection after onset of symptoms was 2.56 months. Typical manifestations included headache (100%), temporal artery tenderness (100%), jaw claudication (20%), polymyalgia rheumatica (53%) and visual manifestations (20%). The erythrocyte sedimentation rate was elevated in all patients. Biopsy was done in 13 patients, with 11 of them being positive. All patients responded to steroids well, with most patients being symptom-free within the first 48 h of treatment.

Conclusions:

Temporal arteritis seems to be underdiagnosed in India, with all patients previously misdiagnosed, and with a mean time from symptom onset to diagnosis of 2.5 months. The clinical presentation of temporal arteritis in India appears to be similar to that of the West, with no gender preference and a slightly younger age group.     

Immunohistology of temporal arteritis: phenotyping of infiltrating cells and deposits of complement components

Summary Deposition of complement factors, immunoglobulins and infiltrating cells was evaluated by immunohistochemical staining in 30 temporal artery biopsy specimens from patients suffering from temporal arteritis and/or polymyalgia rheumatica and in controls. In the temporal arteritis group infiltrating cells, classic complement, alternative complement and lytic complex activation were detected. In specimens from patients suffering from only polymyalgia rheumatica there was unexpected evidence of classic complement and lytic complex activation. We conclude that immuno-histochemistry provides support for the concept of temporal arteritis and polymyalgia being based on the same pathological process.