65-year-old lady underwent mastectomy for carcinoma breast. Later she developed frontai headache, pain in temple region and around eye. Her ESR is 55 mm/hour. What is the most probable diagnosis?
Ans: D (Giant cell arteritis) Ref: Harrison's Principles of Internal Medicine, 18th ednExplanation:Giant Cell Arteritis taka Temporal Arteritis)Inflammation of large sized arteries.Commonly involves extracranial branches of external carotid artery.Most common involved artery - Temporal artery.Associated with polymyalgia rheum ail ca (seen in 40-50% cases of GCA).Common in elderly patients { > 55 years).More common in women.Clinical Featureso Localized scalp tenderness over the temporal artery.o Thick and nodular on palpation,o Jaw claudication - Most specific symptom.o Visual symptoms: Diplopia or amaurosis fugax (Anterior ischemic optic neuropathy),o Fever, Malaise, Fatigue,o Anorexia, Less of weight, Sweats,o Arthralgia.Investigationso Elevated ESR.o Anemia.o Temporal artery biopsy - showing giant cells - Investigation of choice.Treatment - Oral Prednisolone.
Cavernous sinus thrombosis
Meningeal metastasis
Frontal sinusitis
Giant cell arteritis
Immunology and Rheumatology