It's a serious type affecting mainly old patients above 70 years suffering from giant cell arteritis.
Giant cell arteritis:
Idiopathic vasculitis affecting the media and adventitia of the large and medium sized arteries ending in vascular occlusion.
The arteries commonly affected are the superficial temporal, vertebral, opthalmic and short posterior ciliary arteries.
Symptoms:
Acute onset of sudden severe visual loss and periocular pain.
The affection may be bilateral, but simultaneous involvement is rare.
Headache, fever, anorexia, weight loss and muscle pain.
Signs:
Pale swollen optic nerve head surrounded by splinter hemorrhage.
1-2 month the swelling resolves and optic atrophy follows.
Prognosis:
Very poor.
Investigations:
ESR
CRP
Temporal artery biopsy.
Treatment:
I should be initiated rapidly as 65% of the untreated patients may become bilaterally blind in few weeks.
The main aim is to prevent blindness in the fellow eye.
Therapeutic regimen:
Immediate treatment: IV hydrocortisone 250mg together with oral prednisone 80mg/day.
Subsequent treatment: after 3days dose is reduced to 60mg for 3days and 40mg for 4days . The daily dose is reduced by 5mg/week until 10 mg is reached.
Maintenance dose: 10 mg/day for 12 months, but the duration of treatment is variable governed by symptoms, fundus examination and the level of ESR.
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