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Objective Peripheral measurement sites and methods used to determine core body temperature were investigated, as there is still debate about which noninvasive core body temperature measurement method is the most valuable and accurate for each age group. Methods Children aged 1 to 36 months were included in the study. The temperature was measured from the forehead (noncontact cutaneous), temporal artery (TA), axilla, and rectum. The rectal measurement was accepted as the reference measurement. A rectal temperature of ≥38.3°C was defined as fever. Results The noncontact cutaneous, axillary, and TA measurements were 1.2, 1.1, and 0.7°C lower than rectal measurements, respectively (p < 0.001, <0.001, <0.001). The TA and noncontact cutaneous measurements demonstrated a moderate positive correlation with rectal measurements, whereas a strong positive correlation was seen between the axillary and rectal measurements. A cutaneous temperature of 37.8°C was found to have a positive predictive value (PPV) of 100%, negative predictive value (NPV) of 81%, sensitivity of 34%, and specificity of 100% for detecting fever. The respective values were 80, 79.4, 23.5, and 98% for an axillary temperature of 37.5°C, and 90, 86.2, 52.9, and 98% for a TA temperature of 38°C. Conclusion The commonly used fever measurement methods have high PPV and NPV and specificity but low sensitivity. [ABSTRACT FROM AUTHOR]

Background A variety of methods are available for scalp defect closure and necessitate extensive planning. Superficial temporal artery (STA) based local flaps are widely used in the field of scalp and face reconstruction because of their flexibility and rich vascularity. Rotation and transposition techniques are commonly used in the area, however at times result in excessive tension. V-Y advancement allows tension-free closure with reduced post-operative complications. Case presentation A case of scalp defect post multiple craniectomies for a traumatic head injury complicated with subgaleal collection and poor wound healing in a 29-year-old male, is reported. Due to the nature of defect, with underlying fibrosis and previous artificial duraplasty, along with location in the frontotemporal region, a local STA based flap closed in a rotation, transposition and unilateral V-Y advancement pattern was used. Conclusion The challenges encountered in wound closure of complicated post-traumatic and multiple craniectomy cases can be overcome with a modified combined approach which achieves optimal wound closure. [ABSTRACT FROM AUTHOR]

Summary: The present study reports two cases of chronic migraines associated with superficial temporal artery aneurysms. The patients received aneurysm's ligation, with no other surgical maneuvers. In the six months following surgery, both patients were disease-free and did not experience any migraine attacks.Evidence-based medicine ranking: Level V

IntroductionTemporal artery (TA) biopsy is commonly used for the diagnosis of giant cell arteritis (GCA). However, a positive biopsy is no longer mandatory for diagnosis. This study aims to correlate the histopathological findings of TA biopsies in suspected cases of GCA to the clinical presentation in an ophthalmic tertiary eye care center to draw useful conclusions and advocate the possible implementation of guidelines for TA biopsy.MethodsData was collected from patients’ medical records including, demographics, clinical data, and histopathological findings and diagnosis. The 2022 American College of Rheumatology/ European Alliance of Associations for Rheumatology (ACR/EULAR) criteria have been used and partially adopted as a guide to compare the variables between TA biopsy-positive and negative groups as well as the TA biopsy-positive group and the group of patients with TA biopsy showing atherosclerosis.ResultsOut of the total 35 patients who underwent a TA biopsy during the period of 23 years, 22.9% of patients had histopathological findings consistent with GCA and 42.9% had TA atherosclerotic changes, while the remaining 34.3% had histologically unremarkable TA. The mean age of all patients was 66 ± 10.9 years. Slightly more than half were females (54.3%) and the remaining were males (45.7%). In the group with positive TA biopsies, the mean age was 71 ± 8.4 years with a higher female predominance (female-to-male ratio of 5:3). The mean diagnostic clinical score used in our study was higher (7.5 ± 2.33) in the GCA-positive group when compared to the other groups with statistical significance (mean of 4.85 ± 2.01 in patients with overall GCA-negative biopsies and 5.13 ± 2.10 in the group with atherosclerosis). Other three clinical variables that were found to be statistically significant in the GCA biopsy-positive group were scalp tenderness, jaw claudication, and optic nerve pallor.DiscussionThe mean age (71 ± 8.4 years) and the female predominance of GCA in our group of patients with positive TA biopsy (62.5%) was like other reports. In our study 22.9% of performed TA biopsies over the period of the study were positive confirming the diagnosis of GCA on histological exam, which was similar to another report and is considered to be relatively low. The incorporation of increased clinically focused assessments and algorithms, with the aid of the ACR/EULAR criteria, may decrease the frequency of TA biopsies that carries unnecessary cost and risk of procedure-related morbidity. We highly recommend applying the age of ≥ 50 years as an initial criterion for diagnosis, followed by the consideration of the statistically significant clinical features: scalp tenderness, jaw claudication, and optic nerve pallor.

Objective The gold standard for diagnosis of giant cell arteritis (GCA) is a temporal artery biopsy (TAB). We sought for a clinical useful model to predict when an invasive TAB is not necessary to confirm GCA.Methods A prospective cohort study was conducted with patients > 50 years with possible GCA, presenting with newly onset headache and/or visual loss. Demographical, clinical, laboratory findings and histological data were collected.Results Fifty-six (70%) of the 94 patients showed 1 or more halos of the superficial temporal artery branches. Ultrasound-guided biopsy was positive in 28 patients (30%). Four independent variables predicted a positive TAB: weight loss, bilateral headache, positive halo sign and thrombocytosis. The ROC of the model had an area under the curve of 0.932 with a PPV of 83% and a NPV of 94%.Conclusions Weight loss, bilateral headache, a positive halo sign with duplex and thrombocytosis are the most important clinical and laboratory predictors for GCA in a selected group of patients.Significance In patients > 50 years presenting with new onset headache or visual loss with 3 or more of the above mentioned risk factors, a biopsy of the temporal artery is not needed to confirm the diagnosis GCA.KEY MESSAGESIn our study biopsy of the temporal artery was positive in 30% of the patients with possible GCAWeight loss, bilateral headache, a positive halo sign on duplex and thrombocytosis are predictors for GCAThe halo sign had a high sensitivity but a low specificity for a biopsy proven GCA

Giant cell arteritis is an autoimmune disease that affects medium and large caliber vessels, creating deposits of inflammatory clusters on the arterial wall. It is the most common form of large vessel vasculitis, but given the variability of biopsy efficiency and of other diagnostic strategies employed, the diagnosis of this disease is challenging. We report the case of a 69-year-old female patient who presented with neurological deficit and increased bilateral sensation in the temporal region associated with excruciating headache. Workup revealed calcification of the superficial temporal, vertebral and ophthalmic arteries, as well as suggestive findings on Doppler ultrasound such as the halo sign, pointing to superficial temporal arteritis though not excluding the possibility of those calcifications being consistent with atherosclerosis in a patient with advanced chronic renal disease, which has been reported as giving rise to false-positive results. Knowledge of the main differences between the 2 diagnoses is important, given the wide range of diagnostic imaging possibilities which can avoid the need for biopsy.

We report a case of superficial temporal arteriovenous fistula development following frontotemporoparietal hemicraniectomy. This patient presented with intracerebral hemorrhage (ICH) secondary to underlying arteriovenous malformation (AVM) rupture. Following decompressive hemicraniectomy and follow-up successful resection of the underlying AVM, the patient returned to the hospital with a seizure. Repeat angiography was performed, demonstrating no intracranial vascular lesion recurrence. However, an incidental superficial temporal arteriovenous fistula was identified, which was not visualized on initial angiography assessing the prior AVM. These lesions have been treated successfully in the past with surgical, endovascular, or combined approaches. As this patient was scheduled to undergo cranioplasty following AVM resection, the decision to occlude the fistula surgically was made. During cranioplasty, the fistula was identified as an engorged venous complex contiguous with the superficial temporal artery (STA) and was occluded. Follow-up angiography confirmed successful fistula occlusion and the patient has remained asymptomatic. [ABSTRACT FROM AUTHOR]

Objective: This large, retrospective, multicenter study examines the Mayo Clinic experience with temporal artery biopsies over an 11-year period to help form guidelines that would lead to optimal performance of the technique. Methods: Pathology records were identified from all patients at all three Mayo Clinic sites (Rochester, MN; Jacksonville, FL; and Scottsdale, AZ) who underwent temporal artery surgery over an 11-year period, from January 1, 1994, to December 31, 2004. From each report, we extracted demographic information, the length of the temporal artery removed in the biopsy from each side, and the pathologic findings in each specimen. We used logistic regression to assess whether biopsy positivity may be associated with the following factors: biopsy length, age, sex, type (unilateral vs. bilateral), and year of study. Results: Our data set included 3817 temporal artery biopsies performed on 2539 patients at Mayo Clinic. Overall, 681 patients (27%) had a positive biopsy on at least one side. Biopsy length was uniformly noted to have no significant effect on biopsy positivity. Of the 603 patients with a bilateral biopsy, 43 (7%) had a negative initial biopsy followed by a positive result on the contralateral side. Conclusion: Our results support that one can recommend any length of biopsy, within the range our study, without affecting the rate of positivity. Furthermore, we conclude that if a unilateral biopsy is negative on frozen section, then we recommend a second biopsy on the contralateral side to avoid possible missed diagnoses. Key Points • Our paper is a large retrospective study over all 3 Mayo Clinic campuses investigating the association between temporal artery biopsy length and the positivity rate of biopsies. • We also determined the value of performing bilateral biopsies in which the first biopsy was negative on frozen section. • We believe the strength of our study is having one of the largest sample sizes of biopsies in the literature to date including 3817 biopsies. • The sum of our research supports that we found biopsy positivity is not a function of length and, second, bilateral biopsies diagnose up to 7% of disease not otherwise picked up by unilateral approaches. [ABSTRACT FROM AUTHOR]

The gold standard for diagnosis of giant cell arteritis (GCA) is a temporal artery biopsy (TAB). We sought for a clinical useful model to predict when an invasive TAB is not necessary to confirm GCA. A prospective cohort study was conducted with patients > 50 years with possible GCA, presenting with newly onset headache and/or visual loss. Demographical, clinical, laboratory findings and histological data were collected. Fifty-six (70%) of the 94 patients showed 1 or more halos of the superficial temporal artery branches. Ultrasound-guided biopsy was positive in 28 patients (30%). Four independent variables predicted a positive TAB: weight loss, bilateral headache, positive halo sign and thrombocytosis. The ROC of the model had an area under the curve of 0.932 with a PPV of 83% and a NPV of 94%. Weight loss, bilateral headache, a positive halo sign with duplex and thrombocytosis are the most important clinical and laboratory predictors for GCA in a selected group of patients. In patients > 50 years presenting with new onset headache or visual loss with 3 or more of the above mentioned risk factors, a biopsy of the temporal artery is not needed to confirm the diagnosis GCA. In our study biopsy of the temporal artery was positive in 30% of the patients with possible GCA Weight loss, bilateral headache, a positive halo sign on duplex and thrombocytosis are predictors for GCA The halo sign had a high sensitivity but a low specificity for a biopsy proven GCA [ABSTRACT FROM AUTHOR]

Giant cell arteritis (GCA) is the main systemic vasculitis in individuals aged ≥ 50 years. Color Doppler ultrasound (CDS) has an established role in GCA diagnosis and management. This study aims to assess the clinical characteristics associated with a positive CDS evaluation and the impact of additional axillary artery examination on diagnostic sensitivity. We conducted a retrospective analysis of patients undergoing CDS of the superficial temporal arteries, with or without axillary artery assessment, at our hospital, between 2009 and 2023. Patients meeting the new 2022 diagnostic criteria for GCA were included and their characteristics were analyzed according to the presence of the halo sign on CDS. Of the 135 included patients (54 % female, mean age 75 ± 8 years), the halo sign was observed in 57 %, correlating with higher systemic symptom prevalence (61 % vs 42 %, p = 0.035), lower hemoglobin (p < 0.001), and higher erythrocyte sedimentation rate (p = 0.028). The halo sign inversely related to prior corticosteroid therapy (p = 0.033). Patients with axillary halo sign had fewer external carotid symptoms and a higher vertebral halo sign prevalence. Vertebral halo sign was associated with posterior circulation ischemic stroke (65 %, p < 0.001). Axillary artery studies improved diagnostic sensitivity by 9 %. In our study, the halo sign correlated with higher systemic symptoms and analytical abnormalities. Axillary artery examination enhanced CDS sensitivity, linked to severe outcomes like stroke. Prior corticosteroid therapy reduced CDS sensitivity. The correlation of clinical, laboratory, and ultrasound findings provides a more comprehensive understanding of GCA pathogenesis and evolution. [ABSTRACT FROM AUTHOR]

Lobular capillary hemangiomas (LCHs) are a common form of benign vascular tumors originating from the skin and subcutaneous tissues. We have described the case of a 47-year-old man who had presented with a 1-month history of a tender swelling to the right temporal region. Biopsy was performed to rule out temporal arteritis and demonstrated a subset of LCH, now formally known as intravascular LCH. We have described the occurrence of a rare subtype of LCH arising from the intravascular wall of the temporal artery. To the best of our knowledge, this is the only reported case of an intravascular LCH in the Caribbean.

Hypoechoic halo is a typical ultrasound finding in giant cell arteritis (GCA), but it may be a false positive due to arteriosclerosis. Therefore, we focused on the segmental distribution of GCA lesions, defined the luminal irregularity in long-axis images as the string of beads sign, and examined its diagnostic ability. As a result, the C-statistic of hypoechoic halo and string of beads sign was better than that of hypoechoic halo alone (1.00 vs. 0.89). Based on the above, the diagnostic ability of GCA can be improved by adding the string of beads sign to the conventional hypoechoic halo., (© 2024 Wiley Periodicals LLC.)

ABSTRACT: To describe a rare case of symptomatic pseudoaneurysm of the superficial termporal artery. ear old man after cranial trauma. A 79-year-old man presented to our hospital with an appearance of a pulsating swelling in the right front-temporal region, with signs of ischemic suffering of the overlying skin. The patient reported having accidentally fallen about 7 days earlier and reported a non-commotional blunt head injury apparently without any subcutaneous hematoma. The patient underwent an echocolordoppler of the pulsating swelling, reporting the presence of a pseudo-aneurysm of the temporal artery and pre-occlusive carotid stenosis. The patient underwent urgent surgery of the pseudoaneurysm and after 30 days, the patient was once again hospitalized in order to perform the carotid endoarterectomy. The course was regular and the patient was discharged on the third postoperative day. At the level of the right frontotemporal region, complete healing of the skin and the absence of pulsating fear were observed.

Scalp arteries are mainly innervated by trigeminal, facial, and vagal nerves. The ischemic neurodegeneration of the trigeminal ganglion can impede scalp circulation via vasospasm-creating effects. This study was designed to investigate whether there is any link between the vasospasm index of deep temporal arteries and ischemic neuron densities of the trigeminal ganglion after subarachnoid hemorrhage. The study subjects included five normal control rabbits, six sham rabbits, and nine rabbits chosen from a formerly established experimental subarachnoid hemorrhage group created by cisternal homologous blood injection (0.75 mL). These rabbits, all male, were followed up for 3 weeks. The trigeminal ganglion and deep temporal artery vasospasm indexes were examined by stereological methods. Ischemic neuron densities of the trigeminal ganglion and vasospasm index values of deep temporal arteries were compared statistically. Postmortem examinations showed important vasospasms of deep temporal arteries, foramen magnum herniations, and neurodegeneration of the trigeminal ganglion. The mean vasospasm index values and degenerated neuron densities of the trigeminal ganglion were determined as 1.03 ± 0.13 and 10 ± 3/mm3 (p > 0.5) in the control group, 1.21 ± 0.18 and 35 ± 9/mm3 in the sham group (p < 0.005 for sham vs. control), and 2.54 ± 0.84 and 698 ± 134/mm3 in the experimental group (p < 0.0005 for sham vs. control and p < 0.00001 for study vs. control). There was an inverse relationship between the vasospasm index values and the degenerated neuronal density of the trigeminal ganglion. The high degenerated neuron density in the trigeminal ganglion had a facilitative effect on temporal artery vasospasm. Trigeminal ganglion neurodegeneration may promote temporal artery vasospasms after subarachnoid hemorrhage, which has not been previously mentioned in the literature. [ABSTRACT FROM AUTHOR]

Superficial temporal artery pseudoaneurysm is a rare complication of arterial injury developing on the forehead following blunt trauma. There is little written on this entity in the dermatopathology literature. We describe two cases of superficial temporal artery pseudoaneurysm in two men aged 53 and 25 years, one of whom had a recent history of head trauma. This report reviews the classic histopathologic findings of STA pseudoaneurysm and highlights ways to distinguish it from other entities in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Aim: To assess the diagnostic accuracy of temporal artery ultrasound compared with temporal artery biopsy and clinical diagnosis in patients with suspected giant cell arteritis (GCA) over 10 years in an Australian center. Method: Patients presenting to Westmead Hospital with possible GCA from March 2011 to December 2020 were retrospectively identified. The following parameters were obtained from the medical record: clinical presentation, inflammatory markers, temporal artery ultrasound findings, and temporal artery biopsy report. Data were assembled in a 2 × 2 table; sensitivity and specificity of temporal artery ultrasound compared with temporal artery biopsy and clinical diagnosis were calculated. Results: Over the 10‐year study period, 65 temporal artery ultrasounds were performed in 63 patients (n = 65; 61.9% female) with a mean ± standard deviation age of 69.6 ± 12.3 years. Thirteen out of 65 (20%) temporal artery ultrasounds had findings suggestive of GCA. Twenty patients (31.7%) had a clinical diagnosis of GCA irrespective of sonographic or biopsy findings. Compared with temporal artery biopsy, temporal artery ultrasound had a sensitivity of 71.4% and specificity of 93.3%. Compared with clinical diagnosis made by the treating rheumatologist, temporal artery ultrasound had a sensitivity of 55% and specificity of 95.3%. Conclusion: Temporal artery ultrasound is a useful non‐invasive investigation in the assessment of suspected GCA. If positive in the setting of a suggestive clinical presentation, a temporal artery ultrasound probably avoids the need for a temporal artery biopsy. Temporal artery ultrasound could be more widely used in the clinical management of GCA. [ABSTRACT FROM AUTHOR]

Background: Galeal or temporalis muscle flaps have been traditionally used to reconstruct skull base defects after tumor removal. Unfortunately, these flaps do not provide sufficient vascularized tissue for a dural seal in extensive defects. This study describes the successful coverage of large skull base defects using anterolateral thigh (ALT) free flaps. Methods: This retrospective study included five patients who underwent skull base surgery between June 2018 and June 2021. Reconstruction was performed using an ALT free flap to cover defects that included the intracranial space and extended to the frontal sinus and cribriform plate. Results: There were no major complications, such as ascending infections or cerebrospinal leakage. Postoperative magnetic resonance imaging showed that the flaps were well-maintained in all patients. Conclusion: Successful reconstruction was performed using ALT free flaps for large anterior skull base defects. In conclusion, the ALT free flap is an effective option for preventing communication between the nasal cavity and the intracranial space. [ABSTRACT FROM AUTHOR]

Aneurysms of the superficial temporal artery (STA) were first described in 1740, yet it remains a very uncommon post traumatic entity usually associated with sporting activities in young men or recurrent falls in older patients.A 10-year-old boy presented 4 weeks after blunt trauma to the head with a slowly enlarging left temporoparietal swelling. Clinical examination revealed a pulsatile and expansive mass of 4 cm with discoloration of the overlying skin. The ultrasound revealed a pseudoaneurysm of the left anterior superficial temporal artery. Excision was performed under general anesthesia. The mass was exposed, and the proximal and distal branches were ligated. The lesion was entirely removed and hemostasis was easily obtained. Histological examination showed a lesion consistent with pseudoaneurysm.The diagnosis of aneurysms or pseudoaneurysms of the STA can usually be made based on a thorough patient history and physical examination. They are easily treated with few long-term consequences. However, left untreated theses lesions can rupture leading to significant hemorrhage or cause compression of neighboring vessels and nerves. Treatment involves external compression, thrombin injection or surgical resection.

AIMS To describe the feasibility and diagnostic accuracy of 18F-FDG positron emission tomography-computed tomography (PET/CT) of the temporal artery compared with temporal artery ultrasound and histology of the temporal artery in patients with suspicion of having giant cell arteritis (GCA). MATERIALS AND METHODS Patients with suspected GCA were included. PET/CT standard uptake value ratios and the compression sign on ultrasound were assessed for the trunk, and parietal and frontal branches of the temporal artery. Temporal artery biopsies were systematically re-assessed, if available. RESULTS In 17/34 patients, GCA was confirmed. Temporal artery PET/CT confirmed vasculitis in 9/17 patients and was negative in all 17 controls. Nineteen of 34 subjects had a temporal artery biopsy, which was positive in 7 patients. Five of these seven were negative in the preceding PET/CT. Ultrasound confirmed vasculitis in 9/17 patients and was negative in 16/17 controls. In 7/17 patients, PET/CT and ultrasound were positive for temporal arteritis. Two patients had positive findings only on temporal artery PET/CT and two patients showed vasculitis only on temporal artery ultrasound. No temporal artery segments

Giant cell arteritis (GCA) is a systemic inflammatory arteriopathy of medium and large‐sized arteries, predominantly affecting branches of the external carotid artery. Ischemic stroke has been reported in 2.8–7% of patients diagnosed with GCA. The majority of ischemic strokes may involve the posterior circulation as a result of vertebral and/or, less frequently, of basilar artery vasculitis. Prompt diagnosis is crucial since high‐dose corticosteroid treatment is highly effective in preventing the occurrence or recurrence of ischemic complications, including posterior circulation ischemic stroke in cases with vertebrobasilar involvement. Cervical duplex sonography (CDS) of the temporal arteries is a powerful diagnostic tool with high sensitivity and specificity for the diagnosis of GCA. In cases with clinical suspicion or a temporal artery ultrasonographic confirmation of GCA, a detailed evaluation of the cervical, axillary, and intracranial arteries with CDS and transcranial‐duplex‐sonography, respectively, should be part of the ultrasound examination protocol. Specifically, signs of extracranial vertebral artery wall inflammation ("halo" sign) and focal luminar stenoses may be accurately depicted by ultrasounds in high‐risk patients or individuals with ischemic stroke attributed to GCA. In this review, we present three cases of GCA and posterior circulation ischemic complications that were initially evaluated with comprehensive neurosonology protocol and were promptly diagnosed with GCA based on the characteristic "halo" sign in the temporal and vertebral arteries. In addition, we discuss the relevant literature concerning the utility of CDS for the early diagnosis of GCA, focusing on the subtype with extracranial arterial involvement, particularly that of the vertebral arteries. [ABSTRACT FROM AUTHOR]

An 80-year-old female was admitted to the hospital, presenting a pulsatile and painless mass on the right temporal site occurred one month ago following a blunt head trauma. She was under oral apixaban therapy (2x5 mg) due to deep venous thromboembolism for several months. Doppler ultrasound examination and computed tomography angiography revealed pseudoaneursym of the right superficial temporal artery. Patient underwent surgical exploration under local anesthesia. Total rupture of the STA was observed and ligated.

Introduction: Giant Cell arteritis can be difficult to diagnose clinically. In those cases, where there is no certainty, there is more reliance on a temporal artery biopsy and radiological imaging to confirm the diagnosis. The purpose of this article was to identify the standard of care in individuals with suspected Giant Cell Arteritis in a typical district general hospital and to offer a proposed pathway for treatment. Methods: Darent Valley Hospital has been managing Giant Cell Arteritis for many years but there has always been a need for an outlined pathway to identify those at risk of cranial complications like visual loss to improve patient care. We evaluated the management of 70 individuals that had a temporal artery biopsy and followed their treatment journey. We extracted clinical specialist, emergency admission, operation theatre and histological data. We collected clinic follow up data over the following years to identify those that relapsed on treatment, stayed in remission or had complications. We propose a pathway to manage those individuals with Giant Cell arteritis in line with the new advances in treatment. Results: Ten patients were identified that had a histologically positive biopsy. Reassuringly, most individuals with an obvious clinical diagnosis had high dose glucocorticoid treatment commenced before even being referred for a biopsy. Nine individuals had visual ischemia out of which five lost their vision. Conclusion: The presentation of a pathway will help streamline best medical and surgical practice and ensure the availability of urgent specialist treatment and to identify those at risk of ischemic complications.

Temporal arteritis or giant cell arteritis is a form of systemic inflammatory vasculitis closely associated with polymyalgia rheumatica. It may have serious systemic, neurologic, and ophthalmic consequences as it may lead to impaired vision and blindness. Definitive diagnosis is made after histopathologic analysis of a superficial temporal artery (TA) biopsy, which requires a small surgical procedure often under local anesthesia. We investigated whether a noninvasive technique such as duplex ultrasound of the TA could replace histopathological analysis. Eighty-one patients referred to our department for TA biopsy were first screened with a duplex ultrasound for a surrounding halo and/or occlusion of the TA. Presence of visual disturbances and unilateral pain (headache and/or tongue/jaw claudication) was noted before TA biopsy. Pathological analysis was considered the gold standard. Correlation between duplex findings, symptoms, and pathology was determined by Spearman's Rho test. The predictive value of a halo and TA occlusion on duplex were determined by ROC curve analysis. A halo or TA occlusion was found in 16.0% and 3.7% of patients, respectively. Unilateral pain was reported in 96% of cases while 82% complained of visual disturbances. Correlation coefficients for halo and occlusion were 0.471 and 0.404, respectively (P < 0.0001), suggesting a moderate correlation between duplex and biopsy. There was no significant correlation between visual impairment or pain and histologic findings. The ROC curve analysis showed a sensitivity of 53.3% and 20.0%, and specificity of 91.9% and 100% for presence of a halo and occlusion of the TA on duplex, respectively. Arterial duplex is a moderately sensitive but highly specific test for exclusion of temporal arteritis. We observed a moderate correlation between these findings on duplex and histopathological analysis as a gold standard. Arterial duplex may serve as a valuable diagnostic addition to prevent unnecessary surgical procedures and can even substitute biopsy in patients where surgery is not an option. • Arterial duplex is a moderately sensitive but highly specific test for exclusion of temporal arteritis. • It requires a dedicated technician with adequate equipment. • If the duplex ultrasonography indicates presence of temporal arteritis, a biopsy is not strictly necessary. • Negative ultrasonography does not rule out temporal arteritis. [ABSTRACT FROM AUTHOR]

Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis and giant cell arteritis are two different vasculitides that differ in their clinical presentations, treatments and prognoses. Temporal artery involvement occurs rarely in ANCA-associated vasculitis. We present two patients with ANCA-associated vasculitis with temporal artery involvement. [ABSTRACT FROM AUTHOR]

Traumatic Pseudoaneurysm of Superficial temporal artery (STA) is an uncommon entity. Surgical management is the treatment of choice, and endovascular management is also equally feasible particularly for the proximal STA aneurysm. The manual compression for the treatment of STA aneurysm is also described, but it has a high chance of failure. We report a case of traumatic pseudoaneurysm of STA in a pregnant female, successfully treated with a modified manual compression technique. [ABSTRACT FROM AUTHOR]

• Large-vessel imaging demonstrated abnormalities in two-thirds of TAB-negative GCA and should be performed in suspected GCA cases with negative biopsy. • Patients with negative TAB with suspicion of GCA should be seen by a rheumatologist to assist in differential diagnosis of GCA and its mimics. To compare temporal artery biopsy (TAB)-positive giant cell arteritis (GCA) to TAB-negative GCA and patients with GCA mimics retrospectively identified. These two groups were compared to a cohort of patients with TAB performed between 1/1/2009 and 12/31/2010 in which the TAB was negative and alternative diagnosis was provided after a minimum of 6-months of follow-up. Baseline characteristics were compared between groups using chi-square and rank sum tests. 591 study subjects were identified (286 TAB-positive, 110 TAB-negative GCA and 195 TAB-negative GCA mimics) during the respective study periods. Compared to TAB-negative GCA, GCA mimics had similar rates of headache and vision loss but significantly less frequent jaw/limb claudication, arterial bruits and constitutional symptoms, as well as lower platelet levels. Compared to TAB-positive GCA patients, TAB-negative GCA were younger, had shorter time to diagnosis, met fewer 1990 ACR classification criteria and had lower frequencies of polymyalgia rheumatica, jaw claudication and temporal artery abnormalities; but, higher frequency of arm claudication and constitutional symptoms. Among 61 TAB-negative patients with advanced arterial imaging, 43 (69%) had at least one abnormality consistent with GCA. Consideration of alternative diagnoses is requisite in evaluating patients with negative TAB. Advanced imaging assists in identifying occult large-vessel vasculitis and should be employed in all TAB-negative patients with suspicion for GCA. [ABSTRACT FROM AUTHOR]

La arteritis de células gigantes (ACG) es una vasculitis que afecta a arterias de mediano y gran calibre. La biopsia de la arteria temporal es la técnica diagnóstica de elección. Atendiendo a la demanda asistencial que supone, pretendemos evaluar la utilidad de la ecografía Doppler en los pacientes con sospecha de ACG, su sensibilidad y especificidad como prueba diagnóstica y si puede suplir a la biopsia. Se ha realizado un estudio prospectivo de 57 pacientes entre febrero de 2015 y julio de 2016, que han sido diagnosticados con exploración mediante ecografía Doppler y biopsia de arteria temporal. Fueron incluidos 57 pacientes, de los cuales 3 fallecieron durante el seguimiento y una paciente fue excluida del estudio al negarse a la biopsia. Otros 21 pacientes fueron diagnosticados de ACG por un especialista reumatólogo tras un mínimo de 6 meses de seguimiento. Presentaron ecografía positiva 22 pacientes, de los cuales 8 fueron diagnosticados de ACG y 4 de polimialgia reumática. En nuestro estudio, la sensibilidad de la ecografía es del 42,6% y la especificidad es del 65,7%. Otros 19 pacientes presentaron biopsia positiva: todos ellos fueron diagnosticados de ACG. La biopsia presentó una sensibilidad de un 73,7% y una especificidad de un 100%. Según nuestro estudio, la utilidad de la ecografía es limitada y son necesarias nuevas investigaciones para determinar su papel en esta entidad. Giant cell arteritis (GCA) is a vasculitis that affects medium- and large-sized arteries. Temporal artery biopsy is the gold standard for diagnosis. In view of the high demand for temporal biopsies, the purpose of this study is to evaluate the usefulness of Doppler ultrasonography in patients with suspected giant cell arteritis, to determine its sensitivity and specificity as a diagnostic test and to determine whether it would be possible to substitute biopsy for ultrasonography. A prospective study was undertaken including 57 patients from February 2015 to July 2016, who have undergone both ultrasonography and temporal biopsy. A total of 57 patients were included, 3 of whom died during the follow-up, and a patient was excluded from the study when she refused to have the biopsy. Another 21 patients were diagnosed with GCA by a rheumatologist after a minimum of 6 months of follow-up and 22 patients had positive ultrasonography, 8 of whom were diagnosed with GCA and 4 with polymyalgia rheumatica. In our study, the sensitivity of ultrasonography was 42.6%, and the specificity was 65.7%. A total of 19 patients had a positive biopsy, all of them were diagnosed with GCA. In our study, the sensitivity of the biopsy was 73.7% and the specificity was 100%. In view of the data from our study, the usefulness of ultrasonography is questionable, and research about the role of ultrasonography in this disease should be further studied. [ABSTRACT FROM AUTHOR]

John Keats trained as a surgeon at Guy's Hospital from 1815 to 1817. However, despite being qualified, he never practised medicine. His close friend Charles Brown recounted Keats's account of his 'last operation', which involved 'opening a man's temporal artery'. The account raises certain questions: why was Keats opening a man's temporal artery; why did this operation – which presumably Keats did not know would be his 'last' when it took place – stick so clearly in his mind; and did this medical decision have any impact on the personal decision he took to leave medicine? Using records from the London Metropolitan Archives, medical notes from manuscripts maintained by Keats and other surgical students at Guy's Hospital, and published works by eminent surgeons of the day including Astley Cooper and John Bell, we show that Keats was treating a patient with head injuries for his 'last operation'. The essay further explores the significance this operation had for Keats, taking account of his father's unexpected death from a head wound, and suggests that this particular procedure, with its emotional resonances, brought into focus for him an aspect of his temperament that left him uniquely unsuited to practise medicine, and strengthened his conviction to leave the medical profession. [ABSTRACT FROM AUTHOR]

AL amyloidosis (AL) is a systemic disorder due to extracellular tissue deposition of amyloid fibrils, composed of immunoglobulin light chains. Since the description of AL involving temporal arteries in 1986, this disorder has been known as one of the differential diagnoses of giant cell arteritis (GCA). We encountered a case of an elderly female presenting with headache and tender and enlarged temporal arteries, that was pathologically diagnosed with temporal artery involvement of AL due to Bence–Jones-type MM. To our knowledge, this was the first case of AL with temporal artery involvement in Japan, that presented with GCA-like features. Literature review of AL cases with temporal artery involvement showed close similarity between these disorders, but suggested that vasculature involvement (extremity claudication, kidney or heart), macroglossia, carpal tunnel syndrome and normal or low (<0.5 mg/dL) CRP levels may predict AL rather than GCA. Physicians should keep in mind that AL involving temporal arteries can be a pitfall in the diagnosis of GCA, as seen in our and previous cases. [ABSTRACT FROM AUTHOR]

Monoclonal gammopathies complicated by AL amyloidosis can mimic giant cell arteritis (GCA). We hereby present the case of a 63 year old woman in whom symptoms consistent with GCA were the first manifestations of a monoclonal gammopathy of unknown significance (MGUS) associated with amyloidosis. A 63 year old woman was admitted for temporal headache, maseterine claudication, neck and shoulder stiffness. She was recently diagnosed with carpal tunnel syndrome. On physical examination she had prominent temporal arteries, macroglosia and orthostatic hypotension. Muscular strength was normal. She had high ESR and CRP; in this clinical context, GCA was suspected. A gamma spike on serum protein electrophoresis raised the suspicion of monoclonal gammopathy (MG). Immunoelectrophoresis revealed monoclonal bands for IgG and kappa chains. Massive deposits of amyloid and no inflammation were found on temporal artery biopsy. Multiple myeloma and lymphoma were ruled out. A diagnosis of AL amyloidosis complicating MGUS was formulated. She did well on therapy with bortezomib, cyclophosphamide and dexamethasone. Cases published in medical literature reveal amyloidosis mimicking GCA in the setting of established MGUS. As far as we know, this is the first case of MGUS with IgG and kappa chains in which a GCA-like picture induced by amyloidosis was present from the very onset.

Introduction: Temporal artery (TA) biopsy is commonly used for the diagnosis of giant cell arteritis (GCA). However, a positive biopsy is no longer mandatory for diagnosis. This study aims to correlate the histopathological findings of TA biopsies in suspected cases of GCA to the clinical presentation in an ophthalmic tertiary eye care center to draw useful conclusions and advocate the possible implementation of guidelines for TA biopsy., Methods: Data was collected from patients' medical records including, demographics, clinical data, and histopathological findings and diagnosis. The 2022 American College of Rheumatology/ European Alliance of Associations for Rheumatology (ACR/EULAR) criteria have been used and partially adopted as a guide to compare the variables between TA biopsy-positive and negative groups as well as the TA biopsy-positive group and the group of patients with TA biopsy showing atherosclerosis., Results: Out of the total 35 patients who underwent a TA biopsy during the period of 23 years, 22.9% of patients had histopathological findings consistent with GCA and 42.9% had TA atherosclerotic changes, while the remaining 34.3% had histologically unremarkable TA. The mean age of all patients was 66 ± 10.9 years. Slightly more than half were females (54.3%) and the remaining were males (45.7%). In the group with positive TA biopsies, the mean age was 71 ± 8.4 years with a higher female predominance (female-to-male ratio of 5:3). The mean diagnostic clinical score used in our study was higher (7.5 ± 2.33) in the GCA-positive group when compared to the other groups with statistical significance (mean of 4.85 ± 2.01 in patients with overall GCA-negative biopsies and 5.13 ± 2.10 in the group with atherosclerosis). Other three clinical variables that were found to be statistically significant in the GCA biopsy-positive group were scalp tenderness, jaw claudication, and optic nerve pallor., Discussion: The mean age (71 ± 8.4 years) and the female predominance of GCA in our group of patients with positive TA biopsy (62.5%) was like other reports. In our study 22.9% of performed TA biopsies over the period of the study were positive confirming the diagnosis of GCA on histological exam, which was similar to another report and is considered to be relatively low. The incorporation of increased clinically focused assessments and algorithms, with the aid of the ACR/EULAR criteria, may decrease the frequency of TA biopsies that carries unnecessary cost and risk of procedure-related morbidity. We highly recommend applying the age of ≥ 50 years as an initial criterion for diagnosis, followed by the consideration of the statistically significant clinical features: scalp tenderness, jaw claudication, and optic nerve pallor., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Alkatan, AlMana and Maktabi.)