Giant Cell Arteritis

In a nutshell

Granulomatous inflammation of medium and large arteries, especially the cranial branches of the carotid, narrows the lumen and can extend to the posterior ciliary arteries supplying the optic nerve. Because resulting visual loss is sudden and irreversible, high-dose steroids are started immediately on clinical suspicion, never delayed for biopsy.

Classic presentation

A patient over 50 with new unilateral temporal headache, scalp tenderness, jaw claudication and a markedly raised ESR, sometimes with coexisting polymyalgia rheumatica.

Key points

• 1Symptoms map directly onto narrowed named arteries: temporal headache and scalp tenderness (superficial temporal artery), jaw claudication (maxillary artery).