Temporal arteritis- systemic pathology, inflammatory disease a group of vasculitis affecting the temporal and According to other versions, it is called giant cell arteritis,
With age, the arteries wear out, as a result of which pathologies in the body are possible. The disease is natural for an elderly person, whose vessels are exposed to thrombosis and various negative influences.
The disease begins with an immune response, the production of antibodies and complexes remaining on the walls of blood vessels. Cells secrete mediators, resulting in inflammation.
Kinds
Varieties of temporal arteritis:
- for reasons of origin: primary - an independent disease, secondary - arising from ailments affecting small and large arteries;
- by type of inflammation: specific, non-specific;
- along the course of the process - purulent, productive, necrotic;
- according to localization - local or widespread.
Symptoms
The picture of the disease is expressed with symptoms adjacent to other ailments. Untimely appeal to the doctor complicates the diagnosis.
Symptoms of temporal arteritis on initial stage:
- pain in the temples;
- fatigue of chewing muscles;
- decreased reflex when talking and eating.
Symptoms of temporal arteritis in later stages:
- cough for no apparent reason;
- a sore throat;
- nerve insufficiency and blurred vision (sometimes one eye), double vision;
- fever, temperature instability;
- drops in blood pressure;
- thinning of the scalp in the hairy area, which causes pain when touched;
- ocular ischemic syndrome due to poor blood flow;
- sudden weight loss, fatigue.
Symptoms of temporal arteritis may be accompanied by fainting and unconsciousness. Headaches are present during development and in the advanced stage. Patients usually complain of unilateral headache.
External symptoms of temporal arteritis appear as:
- swelling of the artery, which is clearly visible externally (without treatment, the disease can lead to death);
- due to circulatory disorders, vision deteriorates (pain is felt in eyeball, the perceived image becomes blurry, and without timely treatment risk of loss of vision).
General signs
Inflammation of the aorta, arteries and branches is manifested by the following common signs:
- lack of pulse;
- cessation of blood circulation;
- pain in the affected areas;
- loss of consciousness with dizziness;
- atrophied muscle areas.
Forms of the disease
Inflammatory form of temporal arteritis. Symptoms and treatment: fever, headache, intensive weight loss, in which blood-thinning drugs, vascular strengthening and hormonal agents are prescribed.
Atypical form. Absence of symptoms of temporal arteritis, diagnosis is possible on the basis of headache, which can be detected only in chronic stage. Death is not ruled out if you do not see a doctor in time.
Generalized form. The pathological process develops without regard to gender and age, the symptoms of temporal arteritis in young people are expressed by a stroke due to inflammation of the vestibular zone, heart attack, blindness, death. Headache, as a symptom, is rare.
Causes
It is impossible to accurately determine the factors for the occurrence of temporal arteritis. Theoretically, it is capable of provoking the disease genetic predisposition and natural wear and tear of the arteries with the destruction of the walls. Among other causes of the disease are a passive lifestyle, prerequisites for the development of blood clots, which becomes an additional factor causing inflammation.
One of probable causes- taking antibiotics.
Prerequisites for the development of pathology are: weakened immunity, infectious diseases accompanied by known symptoms. The cause of temporal arteritis is the production of antibodies by the body, the development of an autoimmune process and the defeat of large vessels, which is the forerunner of the onset of the disease.
Development of the disease
The production of antibodies in the initial stage occurs due to dysfunction immune system as a result of the interaction of the organism with the infection. Viruses can change cell structure which is perceived by the immune system as an activation foreign bodies. The antibodies that are produced will attach to the vessel walls for destructive purposes. As a result, inflammation occurs inside the large and medium walls of the vessels, which provokes their thickening.
Then granulomas form in the areas of inflammation. Histological examination reveals plasma cells, histiocytes, lymphocytes, eosinophils, plasma and multinucleated cells.
The vessels thicken due to inflammation, become uneven, blood clots appear inside them. This opens not the full area of the artery, but individual segments. The process is asymmetric and mostly affects the temporal artery. Often other parts of the arteries are also involved. Also, changes are found in the coronary, iliac, subclavian, carotid arteries. Aneurysms are visible in the inflamed aorta.
Diagnosis
Diagnosis of temporal arteritis involves the following activities.
In order to accurately diagnose the disease and optimal treatment, a general and biochemical blood test is prescribed, which determines the erythrocyte sedimentation rate and malfunctions of the immune system.
To exclude causes that are not related to the disease, with symptoms of temporal arteritis, diagnosis involves a biopsy of the temporal artery. If the inflammation affects the organ of vision, the same analysis is carried out from the side of the eye.
If the temporal artery is affected, giant cell arteritis is likely, and in the case of other arteries, the diagnosis is not confirmed. The patient will be redirected to specialists of various profiles without receiving treatment pathological process. At the first symptoms, a comprehensive diagnosis is rarely carried out.
Detailed diagnosis of giant cell arteritis:
- examination and evaluation of arterial pulsation;
- detection of shallow arteries, soreness and noise in them;
- recommendations of an ophthalmologist, taking into account the picture of the fundus;
- complete blood count to determine ESR, moderate normo- or hypochromic anemia;
- level detection C-reactive protein for analysis of inflammation;
- biopsy, vascular ultrasound, angiography: the tendency of narrowing of the lumen of the arteries allows you to clarify the disease, indirect methods - to establish a clinical diagnosis.
Complications
If left untreated, other arteries can also be affected, in some cases the kidneys suffer, and ophthalmological problems arise (about 15% of complications in patients).
If the pathological process affects the functions of the central nervous system. Ischemic disorders of this type can lead to a stroke.
The presence of a pathological process in the upper mesenteric artery provokes a malfunction of the gastrointestinal tract, the development of background diseases is not excluded.
Treatment
In the presence of symptoms of temporal arteritis, treatment is carried out by two methods: surgical and therapeutic. When sick on early stage the doctor will prescribe corticosteroids, which will help prevent a heart attack, stroke, loss of vision.
The main treatment is medication: glucocorticoids, prednisolone, vasodilators, vasoconstrictors, blood thinners, aspirin to improve blood circulation, heparin to prevent thrombosis.
With non-standard symptoms of temporal arteritis, the treatment becomes surgical intervention. Usually it is indicated for aneurysm, thrombosis, oncology, the need for prosthetic limbs.
Primary diagnosis is often carried out by doctors of other specialties, while the main method of treating temporal arteritis is corticosteroid therapy. After confirming the diagnosis, hormones are prescribed (50-60 mg / day) with its increase if necessary. The duration of the course is on average 10 months.
In addition to basic therapy appoint symptomatic treatment to normalize blood circulation, and better functioning of organs. In the process of treatment, it is necessary to control the state of the liver, the possibility of osteoporosis, to prevent steroid ulcers of the gastrointestinal tract, to control the level of glucose in the blood.
Therapeutic activities
There is no universal scheme that allows you to effectively treat pathology, but there are a number of basic measures:
- identification and elimination of the source of infection;
- maintenance of functions vascular system and affected organs
- strengthening the immune system and the central nervous system;
- elimination of toxins;
- diet, fractional nutrition, salt restriction, replenishment of potassium and calcium.
- boiled vegetables;
- milk porridges and soups;
- lean meats and fish;
- steam omelets;
- vegetable jelly, juices;
- rosehip decoction;
- green tea;
- fruits and berries.
ethnoscience
Experts warn against uncontrolled treatment folk remedies during advanced disease. But herbal components in the composition of tinctures can improve the patient's immunity, remove negative symptoms. In combination with therapeutic treatment, massages, acupuncture and more are indicated.
With symptoms of temporal arteritis, the treatment of folk remedies is as follows: the use of plants with anti-inflammatory properties that enhance immunity and reduce pain.
- chamomile tea;
- infusion of calendula (flowers);
- infusion, decoction of licorice (roots);
- echinacea tea.
Drink with echinacea is considered preventive. The best results can be achieved in combination with the main therapy, but it is necessary to consult a specialist. Self-treatment without diagnostics is unacceptable.
Prevention
It is impossible to cure the disease at home, the state of health can be improved with preventive methods: light physical exercise, warming procedures, breathing exercises, diet.
Forecast
The prognosis depends on the time of the diagnosis and the treatment started. At an early stage there is a possibility successful therapy, life expectancy is preserved, but more later stages adversely affect the body, reduce its capabilities.
For the young, the forecast will be years, for the elderly - months.
In children, temporal arteritis is usually not observed, except in cases of heredity. In women, the disease is sometimes associated with hormonal changes. In other cases, it manifests itself with the transition to old age.
Recovery depends on the location and massiveness of the affected area. Treatment continues for a year or more, and increases if important arteries are affected and the patient is under constant supervision.
In this article, we discussed the symptoms and treatment of temporal arteritis. The photos posted above show how dangerous this pathology and how important it is to contact a specialist in a timely manner.
This term has other meanings, see Artery (group). Arteries (Latin arteria artery) blood vessels, carrying blood from the heart to the periphery ("centrifugally"), in contrast to the veins in which blood moves to the heart ... ... Wikipedia
- (a. temporalis superficialis, PNA, BNA, JNA) see the list of anat. terms... Big Medical Dictionary
Terminal branch of the outer carotid artery, which supplies blood to the skin of the temporal, frontal and parietal regions, as well as the circular muscle of the eye. Source: Medical Dictionary... medical terms
superficial temporal artery- (a. temporalis superficialis) one of the terminal branches of the external carotid artery. Goes up first in the thickness parotid gland, then under the fascia and skin. Divides into frontal and parietal branches. Blood supply to the parotid gland, skin and muscles of the face, ... ... Glossary of terms and concepts on human anatomy
TEMPORAL SUPERFICIAL ARTERY- (temporal artery) the terminal branch of the external carotid artery, which supplies blood to the skin of the temporal, frontal and parietal regions, as well as the circular muscle of the eye ... Dictionary in medicine
This term has other meanings, see Carotid artery. External carotid artery ... Wikipedia
Arteries of the neck and head. External carotid artery- External carotid artery, a. carotis externa, heading up, goes somewhat ahead and medially to the internal carotid artery, and then outward from it. First, the external carotid artery is located superficially, being covered by the subcutaneous muscle ... ... Atlas of human anatomy
The inflammatory process in the walls of the arteries located in the head, neck, shoulder girdle, due to the deposition of immune complexes in them, is called Horton's disease. Most often, the temporal artery suffers, mainly large and medium-sized vessels of the carotid artery are affected. The blood supply to the brain is disturbed, vision is reduced, patients are worried about throbbing pain in the temples. Treatment is long-term, using corticosteroids for at least a year.
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Causes of giant cell arteritis
The disease has an autoimmune nature. This is confirmed by the detection of immune complexes in the elastic membrane of the arteries, as well as an increase in the titer of antibodies to glycoproteins.
Provoking factors can be:
- herpes infection,
- flu,
- hepatitis,
- tuberculosis.
When examining the tissues of the affected vessel, an antigen is often detected viral hepatitis and antibodies to it. There is evidence of the carriage of genes, the presence of which increases the risk of temporal arteritis, therefore family cases of Horton's syndrome are diagnosed.
The largest number of cases is observed among residents of the Scandinavian countries and North America. Usually the age of patients exceeds 55 years, women get sick more often than men.
Manifestations of arteritis occur after an infection, the disease begins acutely, with elevated temperature, severe pain in the temples on one or both sides. Patients complain of a pulsation in the head region, which increases at night, constantly increasing throughout the month.
Headache is accompanied by numbness and soreness of the skin of the face and scalp, difficulty in chewing, sleep disturbance, severe weakness, pain in the muscles and large joints. Appetite is absent, patients rapidly lose body weight. With damage to the arteries of the brain, signs are observed ischemic stroke: speech disorder, unilateral paresis or paralysis. In rare cases, it may occur.
Deficiency of blood supply optic nerve leads to neuropathy. For several months, the decline in vision progresses, without adequate treatment complete blindness is possible. With a typical course of arteritis, the following signs are noted:
- lack of clear contours of objects,
- paroxysmal decrease in visual acuity.
Watch the video about temporal arteritis:
Diagnostics of the temporal artery
To make a diagnosis, consider elderly age patients, examination data (swelling and redness of the skin of the face, painful nodules on the scalp, dense and tortuous temporal arteries, eyelid prolapse). When examining the pulse on the temporal artery, its filling is low or it is completely absent.
To clarify the degree of activity of the process, a blood test is performed. The following signs are revealed:
- anemia with reduced color index(up to 0.8);
- high content of leukocytes;
- ESR accelerated to 50 mm/h;
- a decrease in albumin levels and an increase in immunoglobulins.
An ophthalmologist, when examining the fundus, detects signs of ischemia of the optic nerve, decreased visual acuity. Also shown are ultrasound of the vessels of the neck and head, computed and magnetic resonance imaging, angiography.
In old age, many diseases await a person, and temporal arteritis is no exception. Horton's disease (second name for temporal arteritis) is similar symptoms with other pathologies, so it is not easy to identify and treat it.
The superficial temporal artery and its branches are available for inspection and especially palpation. The main trunk of the artery emerges from under the zygomatic arch slightly in front of the tragus, goes up, dividing into a number of branches, one of which (the frontal branch) turns forward, crossing the temporal fossa. The main trunk and the frontal branch of the temporal artery are the most accessible for research.
When examining the temporal regions in healthy person arteries are not visible, there is no noticeable pulsation. Arteries can be contoured only in some people after significant physical and emotional stress, after exposure to high temperature(Yuryachaya bath, bath), drinking a lot of tea, coffee.
The constant severity of branching of the temporal arteries, their tortuosity and pulsation is noted in patients with a severe course hypertension, atherosclerotic lesions of the cerebral vessels, with Horton's arteritis.
Palpation of the temporal arteries
Palpation of the temporal arteries is carried out on both sides simultaneously. The terminal phalanges of the II, III, IV fingers are installed in temporal region along the main trunk of the superficial temporal artery. The pulse is evaluated according to the same principles and according to the same qualities as on the radial artery. In addition to the main trunk of the temporal artery, it is necessary to feel all the branches in the region of the temporal fossa, and especially its frotal branch (Fig. 355).
In a healthy person, the pulsation of the temporal argeria is the same on both sides, the pulse is rhythmic, of satisfactory filling and tension, the magnitude and shape of the pulse are not changed, the vascular wall is elastic.
Palpatory physiological and pathological changes pulse on the temporal arteries are similar to those described in the study of the pulse on radial arteries. It is only necessary to emphasize that there is a special, relatively specific type of pathology of these arteries - this is Horton's systemic arteritis (Horton's disease), in which redness, swelling, pain on palpation, induration, tortuosity, decreased pulsation of the temporal artery from one or from two sides.
Temporal arteritis - what is it and what threatens?
Temporal arteritis (giant cell arteritis, Horton's disease) is an inflammatory disease of medium and large arteries. In general, all the arteries of the body are prone to inflammation, but most often the disease affects the arteries of the head and neck. It is this localization of foci of inflammation that makes the disease very dangerous, because among its complications are impaired blood flow, partial or complete blindness, and even a stroke.
Besides, feature disease is the formation of granulomas on the walls of blood vessels, which, as a result, can lead to blockage of the arteries and thrombosis.
People aged 50-70 years are most often affected by this disease.
Most often, the disease develops after 50 years, and its peak falls on the age of 70 years and more. It is noteworthy that women predominate in the risk group - according to statistics, they suffer from arteritis 3 times more often than men.
But, fortunately, temporal arteritis is successfully treated today, which distinguishes it favorably from other inflammatory diseases of the body. And yet, to have at least a superficial knowledge of the causes, symptoms, methods of diagnosing and treating arteritis is sometimes vital.
Causes of temporal arteritis
To date, the exact causes of temporal arteritis are unknown. However, it has been established that important role in the development of the disease will win back natural processes aging of blood vessels and the concomitant destruction of their walls, as well as genetic predisposition.
In addition, in some cases, the impetus for the development of temporal arteritis may be severe infectious diseases, the treatment of which was accompanied by the intake strong antibiotics. In addition, inflammation can be triggered by certain viruses that, once in the body, affect the walls of weakened arteries.
Temporal arteritis - the main symptoms
First alarm symptom, which cannot be ignored - the sudden onset of a sharp pain in the temples and radiating pain in the tongue, neck and even shoulders.
Throbbing pain in the temples may be the first symptom of temporal arthritis.
A clear sign of developing temporal arteritis is a throbbing pain in the temples. Moreover, at the same time as pain symptom a pronounced pulsation of the temporal artery can be felt on palpation.
Very often, attacks of pain are accompanied by partial or complete loss of vision, which can last from several minutes to many hours. In this case, we are talking about progressive inflammation of the arteries and damage to the eye vessels.
In addition, secondary symptoms may also indicate inflammation of the temporal arteries, among which the following should be noted:
Temporal arteritis (giant cell arteritis)
Temporal arteritis, also known as giant cell arteritis, is an inflammatory disease of the medium-sized arteries that supply blood to the head, eyes, and optic nerves. Place your fingers firmly against your temple and you will feel a very pronounced pulsation. This is the temporal artery pulsating. The disease usually affects people over the age of 60 and is manifested by swelling and soreness of the vessels of the temple and scalp. Women suffer from this disease 4 times more often than men.
The main danger of temporal arteritis is loss of vision, although other arteries are also involved in the process with a long course of the disease. This disease is potentially dangerous for vision, but if started in a timely manner proper treatment this can be avoided. The danger lies in the fact that blood passes poorly through the inflamed arteries to the eyes and optic nerves, therefore, without treatment nerve cells retina and optic nerve are destroyed.
Signs (symptoms)
Patients with temporal arteritis usually begin to complain of vision in one eye, but half of them notice symptoms in the fellow eye after a few days without treatment.
Headache
Soreness in the scalp when touched (eg, scratched)
Pain in the temple (may be unbearable)
Temporal arteritis
Temporal (giant cell) arteritis is a fairly rare systemic vascular disease, the main manifestations of which are signs of damage to the vessels of the pool of the external and internal carotid arteries and, very rarely, arterial trunks extending directly from the aortic arch.
This disease in the vast majority of cases is detected in patients of a fairly advanced age (in persons who have not yet turned 50, only isolated cases of the disease are diagnosed). When studying the features of temporal arteritis, it was found that very often the symptoms of this disease occur along with manifestations of polymyalgia rheumatica. Most often, the first manifestations of the disease are found in women aged 60-70 years.
Causes of temporal arteritis
Despite the numerous studies that have been carried out since the first description of the manifestations of temporal arteritis by the American rheumatologists Horton, Magath and Brown in 1932, they have not been reliably established. It is generally accepted that some time before the first signs of the disease appeared, the patient could come into contact with various viruses, bacteria, including Mycobacterium tuberculosis. The possible influence of heredity is also not denied - in those areas of the globe where the population entered into related marriages for a long time, the number of cases is much higher than in the population as a whole (the largest number of cases was found in the Scandinavian countries of Europe and the northern states of the USA).
The influence of factors is also considered to be proven. external environment, under the influence of which disturbances in the activity of the immune system of the patient's body develop - an increase in the sensitivity (sensitization) of the body becomes a starting point in the development of the autoimmune process.
Its main focuses are vascular wall arteries of medium and small caliber. As a result of these processes, the normal blood flow becomes more difficult, the phenomena of dystrophy and ischemia develop in the tissues that are located behind the site of the vessel lesion.
Most often, the inflammatory process in the wall of blood vessels in giant cell arteritis affects the arteries of the head, but in exceptional cases, with the rapid progression of inflammation, damage is possible. coronary arteries, vessels of the kidneys, intestines - parietal blood clots can form in them, causing a progressive narrowing of the lumen of the blood vessel.
Symptoms of temporal arteritis
In the vast majority of cases, the development of severe inflammation of the arteries is preceded by a fairly long prodromal period (the stage of precursors of the disease), which specialists - rheumatologists and angiologists call polymyalgia rheumatica. It is characterized by severe general weakness, deterioration of health, the appearance of constantly subfebrile condition (the temperature does not rise above 37, 70C), which is often accompanied by sweating in the evening and at night. During the same period, discomfort or pain in the muscles and joints of the whole body may occur, causing insomnia in patients, and with the addition of nausea and lack of appetite, the patient's weight loss quickly begins to progress. The duration of the stage of prodromal events can vary from several weeks to several months, and an inverse relationship has been reliably established between the duration and severity of symptoms of polymyalgia rheumatica and the severity of the temporal arteritis itself (the shorter the precursor stage, the more severe the actual vascular lesion).
The most characteristic and subjectively difficult to tolerate symptom is headache. Most often, it focuses in the temporal region, but can spread to the frontal and parietal zones, and very rarely to the back of the head. The pain can be aching or throbbing in nature, and almost always it occurs spontaneously - the patient does not feel the harbingers of an attack (unlike migraine). Unpleasant sensations in the vast majority of cases, they intensify at night, quickly become unbearable, and within a few hours after the onset of the attack, you can see the skin of the head dense and inflamed, sharply painful when trying to palpate the strand - the affected artery.
In cases where the process affects the arteries that supply the area of the face, the patient may experience "intermittent claudication" of the tongue, chewing and very rarely - facial muscles faces, this significantly complicates the normal communication of the patient (difficulties arise when talking) and nutrition (prolonged chewing of food causes sharp pain in the muscles of the face).
In about half of patients, in the absence of adequate treatment, temporal arteritis begins to progress rapidly, and after 30-40 days visual disturbances may appear, the cause of the development of chimes is ischemic damage to the optic nerve or thrombosis of the central retinal artery. In this case, the likelihood of irreversible blindness is high - the atrophy of the optic nerve becomes the cause of its early development.
When the main arteries are involved in the process, changes develop, the distribution area of \u200b\u200bwhich coincides with the areas of blood supply. That is why, when the arteries of the brain are involved in the process, signs of an acute disorder may appear. cerebral circulation or dyscirculatory encephalopathy with a predominance mental disorders. With changes in the coronary arteries, the appearance of angina pectoris and its subsequent progression to myocardial infarction are inevitable; with damage to the aorta, a characteristic clinical picture aneurysms of its arch, with damage to the arteries of the kidneys or intestines, chronic renal failure or attacks of "abdominal toad" develop, respectively.
Diagnosis of the disease
To establish or confirm a diagnosis, it is necessary to perform clinical analysis blood and urine, changes in which are similar to manifestations of other autoimmune diseases- found anemia sharp increase ESR, traces of protein in the urine. IN biochemical analysis blood shows signs of active inflammatory process, coagulogram changes. Accurate Diagnosis can be placed only after a histological examination of a piece of the wall of the temporal artery obtained by performing a percutaneous biopsy.
Treatment of temporal arteritis
Effective treatment of temporal arteritis is impossible without the appointment of glucocorticoid (steroid) hormones, which are used first in an overwhelming dose, and then the daily amount of the drug is very slowly and gradually reduced.
In some cases it also turns out necessary appointment immunosuppressants - these drugs are needed when there is a threat of developing blindness or when signs of a generalization of the process are detected (in this case, patients rarely live more than 6 months without treatment). It is important to remember that with temporal arteritis, a reliable indicator of improvement is not a change in the patient's well-being, but the dynamics of laboratory parameters, so the dose of hormones is selected based on the severity of non-specific laboratory indicators of inflammation (ESR, C-reactive protein).
In addition, with severe violations of blood clotting processes, anticoagulants of direct and indirect action, antiplatelet drugs are prescribed. For improvement general condition the patient is prescribed symptomatic (eliminating individual manifestations of the disease) and metabolic therapy - antianginal drugs for angina pectoris and abdominal toad, vitamins.
Disease prevention
Primary prevention of temporal arteritis is very difficult, because there is no established cause of the development of the disease. Secondary prevention (prevention of exacerbation) consists in lifelong administration of steroid hormones and immunosuppressants.
