A Promising Alternative to Temporal Artery Biopsy for GCA

Abstract

Case Report
A 57-year-old gentleman was referred by GP to
our Acute Medical Assessment Unit with right
sided headache. He described 3 days history of
right fronto-parietal headache with ‘’heaviness’’
and associated blurring of vision and dizziness.
The headache was paroxysmal ‘’coming in waves’’
and did not respond to first line analgesics. He
is an ex smoker, living on his own with no past
medical history of note.
On examination, he had right sided temporal
tenderness without any other findings. CNS
exam was unremarkable. There was no evidence
of proximal muscle weakness.
His laboratory investigations including inflammatory
markers were within normal limits.
A working diagnosis of Temporal Arteritis was
made and he was commenced on High dose oral
Steroids with bone protection and PPI. Temporal
artery biopsy was performed which did not show
any evidence of vasculitis. Ultrasound of Temporal
Artery was organised which showed hyperechoic
thickening of Right temporal artery, highly
suggestive of Temporal Arteritis, thus confirming
the clinical suspicion (see figure). He was
discharged on tapering dose of steroids, PPI and
bone protection and was reviewed periodically in
clinic. He is clinically asymptomatic on treatment.