Middle temporal artery. What is temporal arteritis

Normal blood circulation can be safely called a guarantor of health. Blood supplies tissues nutrients and oxygen, removes decay products and carbon dioxide. Circulatory disorders are dangerous not only because the vessels themselves are damaged, but also because lack of nutrition and the accumulation of waste materials cause disease internal organs, sometimes very difficult.

Arteritis: description

A general name for a group of diseases caused by immunopathological inflammation of blood vessels. At the same time, the lumen of the vessel decreases, which impedes blood flow, and conditions for the formation of a blood clot are created. The latter can completely block the blood supply, which leads to severe organ diseases. Also, with inflammation, the likelihood of aneurysm formation increases.

All vessels are susceptible to damage: arteries, arterioles, veins, venules, capillaries.

1. Temporal arteritis or giant cell- inflammation of the aortic arch. In this case, not only the temporal artery suffers, but also other large vessels of the head and neck, but the symptoms are most pronounced in the artery.
2. Takayasu syndrome is a lesion of the aorta.
3. Medium vascular arteritis- polyarteritis nodosa and Kawasaki disease, affecting the coronary vessels.
4. - polyangiitis, granulomatosis and others.
5. Inflammation affecting any blood vessels- Cogan's syndrome, Behçet's disease (vessels of the mucous membrane and skin are affected).

There are also vasculitis of individual organs, systemic, and secondary. Most of them are accompanied by severe fever.

Causes

To date, they remain unknown. The most obvious are age-related changes when it comes to diseases of large vessels. With age, the walls of arteries and veins lose elasticity, which contributes to the occurrence of immune inflammation.

However, such an explanation can only be given for some types of vasculitis. Thus, Behcet's disease affects men 3 times more often in the age group from 20 to 30 years, and Kawasaki disease is observed in children under 5 years of age.

There is a certain connection with the functioning of hormonal systems, since women are more susceptible to inflammation of large arteries.

Also judging by medical statistics there is also some genetic predisposition. Giant cell arteritis is common among whites. And Takayasu syndrome affects only Asian women under 30 years of age. Representatives of both the European and Asian races are equally susceptible to systemic vasculitis, but those living at latitudes from 30 to 45 degrees in the Middle East from Japan to Mediterranean Sea. These observations have not yet been explained.

There are primary and secondary forms of arteritis.

1. Primary - vasculitis occurs as an independent phenomenon. As a rule, inflammation is associated with age-related changes, based on the fact that it mainly affects people over 50 years of age.
2. Secondary - inflammation is a consequence of another disease, usually a severe infectious disease. The most dangerous infections are those caused by Staphylococcus aureus and hepatitis virus.

Symptoms of the disease

The disease is somewhat different from the usual form of vasculitis. A kind of complexes are formed in the walls of the vessel - multinucleated giant cells, hence the name. The vertebral and optic arteries, as well as the celiac artery, are affected. The disease is autoimmune in nature: foreign formations provoke the production of antibodies that attack the vascular tissue.

The picture shows manifestations of giant cell arteritis, click on the photo to enlarge it.

In addition to the vessels, the organs associated with them are also affected. If the optic artery is damaged, visual acuity drops sharply, and at the stage of thrombus formation, complete blindness occurs. When the vertebral artery is damaged, a thrombus causes.

The symptoms of the disease are:

• acute strong pain in the temple area, radiating pain to the neck, tongue and even shoulder. May be accompanied by partial or complete temporary loss of vision, which indicates damage to the ocular vessels;
• the pain symptom is of a pronounced pulsating nature and is accompanied by painful pulsation of the artery, easily felt upon palpation;
• pain in the temples intensifies during chewing;
• hairy part the head on the side of the damaged artery is painful to the touch;
• there is drooping of the eyelid;
• double vision, blurred vision, painful sensations in the eyes;
• The temple area is usually swollen, and redness may be observed.

The disease is not accompanied by fever, but weight loss, decreased appetite and lethargy are noted.

Inflammation may occur along with temporal arteritis facial artery and polymyalgia rheumatica. The latter is accompanied characteristic pain and stiffness in the muscles of the shoulder and pelvic girdles.

Diagnosis of the disease

The consultant in this area is a rheumatologist. Diagnosis includes clarification of the clinical picture based on the patient’s words and laboratory tests.

• Blood analysis - high speed Erythrocyte sedimentation indicates the course of inflammatory processes. The second indicator is produced by the liver and enters the bloodstream during inflammation and injury. Both signs are indirect, but their level serves as a good indicator for treatment.
• Biopsy - a fragment of an artery is examined. Symptoms of vasculitis coincide with those of some other diseases, and diagnosis allows you to more accurately determine the disease. If, when studying the drug, multinucleated giant cells are detected, the diagnosis is confirmed. It is worth noting that even biopsy data cannot give a 100% result: cellular conglomerates are localized, and the chance that a non-inflamed section of the artery will be included in the sample is not so small.

Treatment

Treatment often begins before diagnosis is completed. The reason for this is the severity of the consequences of untimely intervention - stroke, blindness, and so on. Therefore, if the symptoms are pronounced, the course begins immediately after treatment.

Unlike many other inflammatory diseases, temporal arteritis can be completely healed, although it takes a lot of time.

Therapeutic treatment

It is carried out when the diagnosis is not burdened with additional complications.

• Glucocorticoid drugs - for example, prednisolone. At the first stage, the drug is administered in large doses. If the condition improves, the dose is reduced, but active treatment is designed for at least 10-12 months. The course of treatment can last up to two years depending on the severity of the lesion. If glucocorticoids are poorly tolerated, methotrexate, azathioprine and other similar drugs are used, however therapeutic effect they are significantly lower. Prednisolone is used for almost all types of arteritis and today seems to be the most effective remedy.
• Blood tests are performed continuously throughout treatment. An important diagnostic criterion for vasculitis is a decrease in the level of red blood cells and hemoglobin.
• If there is a threat of vision loss, prednisolone pulse therapy is prescribed: the drug is administered intravenously for 3 days, then the patient receives the medicine in tablet form.
• Vasodilators and medications that prevent the formation of blood clots are prescribed. To prevent the latter, Heparin can be added in the form of subcutaneous injections.
• The composition of the blood during inflammation significantly affects the course of the disease. To improve its state of aggregation, aspirin, chimes, and the like are used.

Surgical intervention

Treatment is indicated in cases where complications develop, for example, thrombosis of a vessel, the formation of an aneurysm, as well as in the presence of cancer.

In case of acute arterial obstruction, they resort to angioprosthetics or bypass surgery. But such extreme cases are rare.

Prevention

Unfortunately, no measures can be taken to prevent temporal arteritis. With the autoimmune nature of the disease, the body's cells are attacked by their own antibodies, and the mechanism of this phenomenon remains unclear. However, execution general recommendations to strengthen the body and immune system reduce the risk of inflammation.

Temporal arteritis can be completely cured with timely treatment, and, most importantly, following the doctor’s prescriptions. The nature of the symptoms allows you to quickly establish a diagnosis and take timely measures.

Temporal arteritis – what is it and what does it mean?

Temporal arteritis (giant cell arteritis, Horton's disease) is an inflammatory disease of the medium and large arteries. In general, all arteries of the body are susceptible to inflammation, but most often the disease affects the arteries of the head and neck. It is precisely this localization of foci of inflammation that makes the disease very dangerous, because its complications include impaired blood flow, partial or complete blindness, and even stroke.

In addition, a characteristic feature of the disease is the formation of granulomas on the walls of blood vessels, which can consequently lead to blockage of the lumens of the arteries and thrombosis.

People aged 50-70 years most often suffer from this disease.

Most often, the disease develops after 50 years of age, and its peak occurs at the age of 70 years or 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 from other inflammatory diseases of the body. And, nevertheless, having 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 will play a role in the development of the disease natural processes aging of blood vessels and 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 taking strong antibiotics. In addition, inflammation can be triggered by certain viruses, which, when entering the body, affect the walls of weakened arteries.

Temporal arteritis - main symptoms

First alarming symptom, which cannot be ignored - the sudden onset of 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 throbbing pain in the temples. Moreover, simultaneously with pain symptom a pronounced pulsation of the temporal artery can be felt upon 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 indicate inflammation of the temporal arteries, among which the following are worth noting:

Temporal arteritis (giant cell arteritis)

Temporal arteritis, also known as giant cell arteritis, is an inflammatory disease of the medium-sized arteries that supply 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 tenderness 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 with a long course of the disease, other arteries are also involved in the process. This disease is potentially dangerous for vision, but if started in a timely manner proper treatment this can be avoided. The danger is that blood flows poorly to the eyes and optic nerves through the inflamed arteries, so without treatment nerve cells retina and optic nerve die.

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

Pain in the scalp when touched (for example, scratching)

Temple pain (can 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 external and internal carotid arteries and, very rarely, arterial trunks extending directly from the aortic arch.

In the vast majority of cases, this disease is detected in patients of fairly advanced age (only isolated cases of the disease are diagnosed in persons under 50 years of age). When studying the characteristics of temporal arteritis, it was found that very often the symptoms of this disease occur together 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 numerous studies that have been conducted since the first description of the manifestations of temporal arteritis by 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 has entered into consanguineous marriages for a long time, the number of cases is significantly higher than in the population as a whole (the largest number of cases were identified in the Scandinavian countries of Europe and the northern states of the USA).

The influence of factors is also considered proven external environment, under the influence of which disturbances develop in the activity of the immune system of the patient’s body - increased sensitivity (sensitization) of the body becomes a trigger point in the development of the autoimmune process.

Its main foci are concentrated in the vascular wall of medium- and small-caliber arteries. As a result of these processes, normal blood flow is hampered, and the phenomena of degeneration and ischemia develop in the tissues that are located behind the site of vessel damage.

Most often, the inflammatory process in the vascular wall with giant cell arteritis affects the arteries of the head, but in exceptional cases, with rapid progression of inflammation, damage to the coronary arteries, kidney vessels, and intestines is possible - 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, and the appearance of constant low-grade fever (the temperature does not rise above 37.70 C), which is often accompanied by sweating in the evening and at night. During the same period, unpleasant sensations or pain may occur in the muscles and joints of the whole body, causing insomnia for patients, and with the addition of nausea and lack of appetite, the patient’s weight loss quickly begins to progress. The duration of the prodromal stage can vary from several weeks to several months, and an inverse relationship has been reliably established between the duration and severity of the symptoms of polymyalgia rheumatica and the severity of temporal arteritis itself (the shorter the precursor stage, the more severe the vascular damage itself).

The most characteristic and subjectively difficult to tolerate symptom is headache. Most often it focuses on 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 warning signs of an attack (unlike migraine). Unpleasant sensations in the vast majority of cases intensify at night, quickly become unbearable, and within a few hours after the onset of the attack, you can see the scalp being thick and inflamed, sharply painful when trying to palpate the cord - the affected artery.

In cases where the process affects the arteries supplying blood to the facial area, the patient may experience “intermittent claudication” of the tongue, chewing, and very rarely - facial muscles face, this significantly complicates the patient’s normal communication (difficulties arise when talking) and nutrition (prolonged chewing of food causes sharp pain in the facial muscles).

In approximately half of patients, in the absence adequate treatment Temporal arteritis begins to rapidly progress, and after 30-40 days, visual impairment may appear; the cause of the development of arteritis is ischemic damage to the optic nerve or thrombosis of the central retinal artery. In this case, there is a high probability of irreversible blindness - the cause of its early development is atrophy of the optic nerve.

When the main arteries are involved in the process, changes develop, the area of ​​distribution of which coincides with the areas of blood supply. That is why, when the cerebral arteries are involved in the process, signs of an acute disorder may appear. cerebral circulation or discirculatory encephalopathy with a predominance mental disorders. With changes in the coronary arteries, the appearance of angina pectoris and its subsequent progression to myocardial infarction is inevitable; with damage to the aorta, a characteristic clinical picture aneurysms of its arch; when the arteries of the kidneys or intestines are damaged, chronic renal failure or attacks of “abdominal toad”, 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 the manifestations of other autoimmune diseases- anemia is detected, sharp increase ESR, traces of protein in urine. A biochemical blood test reveals signs of an active inflammatory process and changes in the coagulogram. 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 prescription 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 is also necessary to prescribe immunosuppressants - these drugs are needed when there is a threat of developing blindness or when signs of generalization of the process are identified (without treatment, patients in this case rarely survive more than 6 months). 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, therefore the dose of hormones is selected based on the severity of nonspecific laboratory parameters of inflammation (ESR, C-reactive protein).

In addition, in case of severe disorders of blood clotting processes, direct and indirect anticoagulants and 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 pain, vitamins.

Disease prevention

Primary prevention of temporal arteritis is very difficult, because there is no established cause for the development of the disease. Secondary prevention (prevention of exacerbation) consists of lifelong prescription of steroid hormones and immunosuppressants.

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General and microsurgical anatomy

As is known, in soft tissues The following five main layers of the head can be distinguished: skin with hair; subcutaneous fatty tissue; aponeurotic helmet, which continues into the temporal region in the form of superficial temporoparietal fascia; loose connective tissue and pericranium (Fig. 21.1.1).

Rice. 21.1.1. Scheme cross section tissues at the level of the temporal fossa.
1 - tendon helmet; 2 — temporal bone; 3 - periosteum; 4 - loose connective tissue layer; 5 - fascia of the temporal splint 6 - temporalis muscle; 7 - temporoparietal fascia; 8 - superficial temporal vessels; 9 - skin; 10 - subcutaneous fatty tissue

Temporoparietal fascia (superficial) starts from the arch zygomatic bone, is located above the fascia of the superficial temporal muscle and is a continuation of the superficial muscular-aponeurotic system that supports facial muscles(including frontal and occipital).

The temporoparietal fascia is separated from the deep fascia covering the temporalis muscle by a layer of loose connective tissue, which is most pronounced anteriorly and above the auricle, and thins towards the periphery.

Vessels. Nutrition of the skin of the temporo-parietal region is provided by the superficial temporal vascular bundle, which is the terminal branch of the external carotid bundle and emerges from the upper part of the parotid salivary gland 1.5 cm anterior to the tragus auricle.

Most often, veins are located posterior and deeper than the artery. The artery and vein lie in the subcutaneous fatty tissue on the temporoparietal fascia and approximately 7 cm above top edge The tragus is divided into two (anterior and posterior) branches, and sometimes more branches (Fig. 21.1.2).

Rice. 21.1.2. Branching diagram of the superficial temporal artery.

The diameter of the artery is slightly smaller than the diameter of the veins and ranges from 1.8 to 2.2 mm, the length of the vascular pedicle is up to 4-5 cm.

Nerves. Together with the vessels, the cutaneous parietal-piscal nerve passes over the superficial fascia, and the branches of the facial (motor) nerve pass under the fascia (Fig. 21.1.3).

Rice. 21.1.3. Location of the cutaneous-temporal nerve (1) and branches facial nerve (2).

Adoption and transplant options. Fascial temporoparietal flap

The most commonly used in surgery is the fascial temporoparietal flap. Its advantages include relatively big sizes(up to 17 x 14 cm), small, uniform thickness and good blood supply with a relatively large diameter of the feeding vessels.

The fascial flap is taken from the preauricular T-shaped access within the scalp. The vascular bundle is easily identified in the subcutaneous fatty tissue anterior to the upper edge of the auricle.

After this, the skin with fiber is dissected, dissecting the tissue under hair follicles. The latter circumstance, as is known, is very important in the prevention of focal baldness.

As you move away from the base of the flap, the isolation of the fascia becomes more and more difficult due to its increasingly dense connection with the skin by fibrous bridges.

When isolating the anterior portion of the tissue complex, it is advisable to use a neurostimulator to identify and maintain the anatomical continuity of the frontal branches of the facial nerve. The auriculoparietal cutaneous nerve may be included in the flap.

The successful use of a fascial flap for plastic surgery of defects of the hand, forearm, foot, and ankle joint and other zones.

The temporoparietal complex of tissues can be used as a polyflap with the release of fragments of fascia on the branches of the superficial temporal artery. This feature is especially important for plastic surgery of tissue defects of the hand and fingers.

One of the advantages of the temporoparietal fascial flap is the ability to prepare a two-layer graft from two sections of fascia folded together, one of the surfaces of which can be previously covered with a split-thickness skin graft.

The flap may include skin, periosteum (beyond the temporalis muscle insertion), and the outer cortex of the parietal bone.

The disadvantages of the flap include the possibility of subsequent development of focal baldness and the risk of damage to the superficial branches of the facial nerve. The possibility of expansion of the postoperative scar due to tension on the suture line during closure of the donor defect was noted. In this regard, this complex of tissues is recommended for use primarily in women. In men with their short hairstyle, it is preferable to use the fascial periscapular complex of tissues.

Fascial cutaneous flaps

Retroauricular flap, including hairline. This tissue complex can be transplanted onto posterior branch superficial temporal artery. The flap is located behind the ear, and part of its skin has hair. Thus, its transplantation allows the formation of a hairline border.

Indications for surgery are previous injuries or operations that resulted in focal baldness on the hairline in the temporal region.

Taking the flap. The superficial temporal vessels are found anterior to the auricle and isolated in the distal direction, preserving the branches going to the flap.

The veins draining the flap may run alongside or posterior to the superficial temporal artery. In the first case, the veins and artery run together within the superficial fascia above the deep fascia.

When the veins are located to the side and posterior to the artery, they can pass in the subcutaneous fatty tissue above the auricle. In this case, this area (without skin) must be included in the flap. The flap is then removed behind the ear downwards, passing under the superficial fascia.

If the posterior venous branch is not identified or is located too high, then stage-by-stage (delayed) formation of the flap is advisable.

If venous drainage from the flap is insufficient, the posterior auricular vein can be used to provide sufficient venous drainage.

It is important to note that when choosing a donor area, it is necessary to take into account the location of the border and the direction of hair growth, which must correspond to the characteristics of the damaged area.

Preauricular cutaneous-cartilaginous flap. It includes an area of ​​skin anterior to the upper third of the auricle and the helix of the auricle with the skin covering it. These fabrics allow you to perfectly shape the wing of the nose and the dome of the tip of the nose. The flap is isolated on the superficial temporal vessels. Closure of the donor defect may require repositioning of the helix to reduce the cosmetic defect.

Other flaps can be created on branches of the superficial temporal artery. On the posterior branch of the latter, an occipito-parietal flap can be isolated, the central axis of which is located in the anteroposterior direction approximately 7 cm above the tragus of the auricle.

IN AND. Arkhangelsky, V.F. Kirillov

Arteritis – common name a whole group of diseases caused by immunopathological inflammatory processes occurring in blood vessels. Inflammation leads to a narrowing of the vascular lumen, obstruction of blood flow and the formation of favorable conditions for thrombus formation. Violation of the blood supply to organs and tissues ends with their ischemia and development serious illnesses. All vessels are subject to inflammation: arteries, veins and capillaries. The disease brings many problems and troubles to patients.

Arteritis has several names - angiitis, Horton's disease, temporal arteritis. All these terms refer to the same pathology - inflammation of the vascular wall.

Arteritis is of origin:

• Primary, arising as an independent nosological unit - giant cell arteritis;
• Secondary, resulting from other pathologies.

According to the nature of inflammation, arteritis is divided into specific and nonspecific, according to type pathological process– purulent, necrotic, productive and mixed; according to the localization of the lesion in the vessel wall - endoarteritis, mesoarteritis, periarteritis, panarteritis. Often inflammation of the vascular wall is combined with thrombosis. This condition is called thrombarteritis.

The disease usually develops in older people aged 50-70 years. In persons younger age pathology occurs only in exceptional cases. Horton's syndrome is a disease of old people, but there may be rare exceptions to any rule. According to statistics, it develops more often in men aged 20-30 years, in children under 5 years of age, inflammation of large arteries – in women of reproductive age.

Etiology

The causes of giant cell arteritis currently remain unknown. The pathology is based on autoimmune inflammation. Age-related changes, occurring in the walls blood vessels, lead to a loss of their elasticity, which further aggravates the situation and contributes to the development of the disease.

There are several theories for the development of arteritis:

1. Hereditary predisposition - this disease is often found in members of the same family and almost always in identical twins.
2. Infectious theory - the presence of antibodies and antigens in the blood of people who have had the flu, staphylococcal infection, hepatitis.
3. Autoimmune theory, according to which Horton's syndrome is classified as collagenosis. Foreign formations provoke the production of antibodies that attack the vessel’s own tissues. In some patients with arteritis, the same signs of damage to the connective tissue and blood vessels were revealed as in periarteritis nodosa. Arteritis often occurs in patients with dermatomyositis and scleroderma.

Temporal arteritis primarily affects large blood vessels, affecting the capillaries only in rare cases. Inflammation of the vascular wall leads to disruption of tissue structures, narrowing of the lumen of the vessel, organ ischemia, deterioration of local blood flow, and the formation of a blood clot that completely blocks the lumen. Thinned and stretched walls of arteries or veins protrude, an arterial aneurysm develops, which, against the background sharp increase blood pressure may burst.

The clinical picture of the disease is determined by the localization of the lesion. Patients develop acute cerebrovascular accident, loss of vision, and stroke. Inflammation usually occurs carotid arteries, aorta and other vascular structures that supply blood to areas of the head and cerebral cortex, the optic nerve, the organ of vision, and some internal organs.

artery changes in giant cell arteritis

Inflammation in arteritis is focal or segmental in nature: vessels are not affected along their entire length, but in individual areas or segments. The elastic membrane is infiltrated by lymphocytes, the intima thickens, plasma cells, epithelial cells, histiocytes, and multinucleated cells accumulate in it, forming extensive granulomas. Multinucleated giant cells are complexes circulating in the blood that give the disease its name.

In the blood of patients with exacerbation of arteritis, a large number of immune complexes, lymphoblasts, and serum immunoglobulins are found.

Video: temporal arteritis – medical animation

Symptoms

General symptoms of pathology that precede the appearance of specific symptoms:

• Fever,
• Weakness,
• Lack of appetite,
• Hyperhidrosis,
• Myalgia,
• Noticeable weight loss.

With arteritis, the temporal artery becomes inflamed in 90% of cases, and temporal arteritis develops. Patients complain of constant headache varying degrees intensity. The temporal arteries swell, swell, pulsation weakens, and they become painful. When arterial blood vessels supplying the brain are damaged, corresponding symptoms appear.

visible manifestations of temporal arteritis

Headache occurs in 70% of patients with arteritis. This is the first symptom of the disease, which is diffuse in nature. When palpating these arteries, the pain becomes diffuse and unbearable. Inflamed vessels become denser and become tortuous, skin they become red and swollen. Temporal arteritis is manifested by pain in the temples, radiating to the neck, lower jaw, shoulder. The pain is severe, throbbing, aggravated by palpation and chewing. Vision is impaired, eyelid drooping, double vision and pain in the eyes are observed. On the arteries of the neck and upper limbs the filling and frequency of the pulse changes: it first weakens and then disappears completely. The muscles of the limbs weaken, polymyalgia develops - special shape pathology, manifested by pain and stiffness in the muscles of the shoulder, pelvis, arms and legs.

For inflammation of the maxillary and facial arteries there is pain and numbness masticatory muscles, tongue damage, toothache. Burning pain under the jaw reaches upper lip, nose and corners of the eyes. These signs are caused by insufficient blood supply to the corresponding muscles.

The disease affects the blood vessels supplying the organs of vision. In patients, the optic nerve becomes inflamed, choroid eye, iris, conjunctiva, sclera, diplopia and ptosis develop upper eyelid. These symptoms may be temporary or persistent. Inflammation of the branches of the ophthalmic and ciliary arteries leads to their thrombosis, optic nerve ischemia and blindness.

One of the most common forms of arteritis is polyarteritis nodosa.. This is pathology lower limbs, developing in individuals leading a sedentary lifestyle and in long-term smokers. Patients experience causeless fever, sudden weight loss, severe pain in the muscles and joints of the legs. On palpation, areas of compaction and nodules are detected. These are arterial aneurysms.

Diagnostics

The diagnosis and treatment of arteritis is carried out by rheumatologists with the involvement of specialists from other medical specialties– nephrologists, dermatologists, hematologists, cardiologists, neurologists, psychiatrists. Identify pathology and make the correct diagnosis initial stages pretty hard.

Basic diagnostic methods to detect arteritis:

1. Conversation with the patient
2. General examination of the patient, pulse measurement, auscultation of the heart and lungs,
3. General and biochemical analysis blood - increase in ESR And C-reactive protein, moderate anemia,
4. Ultrasound of blood vessels,
5. Artery biopsy - identification of multinucleated giant cells,
6. Arteriography,
7. Fundus examination,
8. Ophthalmoscopy - detection of ischemic neuritis of the optic nerve.

Treatment

The pathology is based on a powerful inflammatory process, which only corticosteroids can cope with.

They suppress inflammation within the arteries, while at the same time being a reliable prophylactic agent. Patients are prescribed high doses of corticosteroids for oral or parenteral administration - “Decortin”, “Prednisolone”, “Medopred”, “Prednisol”. Tablets are taken 3 times a day, mainly after meals. The duration of treatment with Prednisolone ranges from 12-24 months. Prednisolone is by far the most effective remedy in the treatment of arteritis. In almost all patients, it gives a clear therapeutic effect: body temperature normalizes, symptoms of intoxication and asthenia disappear, and ESR decreases. Glucocorticoid drugs have a number of side effects

, including hyperhidrosis, the appearance of hematomas, swelling of the face, weight gain, osteoporosis in the elderly, psycho-emotional breakdowns.

Persons who do not tolerate glucocorticoids well are treated with Methotrexate, Azathioprine and other drugs in this group. To improve the rheological properties of blood

and its physical state, Aspirin, Dipyridamole, Curantil and other angioprotectors are prescribed. They restore blood microcirculation in the affected artery, reduce the risk of hypercoagulation, and eliminate vasoconstriction. To prevent blood clots

and optimization of blood flow, heparin therapy is carried out. Treatment with Heparin lasts five to six days, after which they move on to the use of indirect anticoagulants, for example, Warfirin. If infectious factors play a role in the development of arteritis , patients are prescribed antibacterial or antiviral drugs

With the development of such complications of arteritis as thrombosis of a vessel, oncopathology, formation of an aneurysm, it is required surgery. In such cases, angioprosthesis or bypass surgery is performed. During the operation, the affected areas are removed vascular bed, restoring vascular patency.

ethnoscience

It should be remembered that the means traditional medicine only temporarily relieve pain and reduce the intensity of other signs of inflammation. They fail to deal with the source of the problem. It's just " ambulance» to alleviate the condition and relieve discomfort. If the symptoms listed above appear, you should consult a doctor and undergo a full examination.

To relieve headaches, decoctions and infusions of medicinal herbs are used:

With timely consultation with a specialist and adequate therapy, the prognosis of the disease is quite favorable. Minimal changes occur in the body pathological changes allowing patients to live a full and normal life.

Patients who ignore constant headaches risk becoming disabled. Advanced forms of arteritis lead to unfavorable and quite serious complications that are difficult to treat and continue to progress.

Video: temporal arteritis in the program “Live Healthy!”

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IN this moment answers the questions: A. Olesya Valerievna, candidate of medical sciences, teacher at a medical university

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The superficial temporal artery and its branches are accessible to 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 frontal branch of the temporal artery are the most accessible for research.

When examining the temporal areas of healthy person the arteries are not visible, there is no noticeable pulsation. Arteries can be contoured only in some people after significant physical and emotional stress, after being in conditions high temperature(hot bath, sauna), drinking large amounts of tea and coffee.

Constant severity of the branches of the temporal arteries, their tortuosity and pulsation are observed in patients with severe disease hypertension, atherosclerotic lesions of 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 the temporal region along the main trunk of the superficial temporal artery. The pulse is assessed 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 area of ​​the temporal fossa, and especially its phrotal branch (Fig. 355).

In a healthy person, the pulsation of the temporal argeria on both sides is the same, the pulse is rhythmic, satisfactory filling and tension, the size and shape of the pulse are not changed, vascular wall elastic.

Palpation physiological and pathological changes in the pulse on the temporal arteries are similar to those described when studying 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 in the temporal region there is redness, swelling, pain on palpation, compaction, tortuosity, decreased pulsation of the temporal artery from one or on both sides.