LAUSR

A 74-year-old woman presented with 6 weeks of fevers and right neck pain. At the time of symptom onset, she also experienced bilateral temporal headache with scalp allodynia, which resolved within 3 weeks. Physical examination revealed a pulseless, enlarged right temporal artery (Fig. 1) and a tender right carotid artery. The erythrocyte sedimentation rate was 78 mm/h. Contrast-enhanced computed tomography (CT) revealed wall thickening of the thoracic aorta and its carotid and subclavian branches, with a double-ring appearance (Fig. 2). The patient was diagnosed with giant cell arteritis (GCA) and treated with oral prednisolone. Within 10 days, the patient’s symptoms had improved. GCA is a vasculitis of medium and large vessels. It rarely occurs before the age of 50 years. In one study, headache was present in 86% of cases. However, the headache may be progressive, spontaneously subside, or wax and wane in intensity. Carotid artery tenderness has been reported in 7% of GCA cases. Temporal artery biopsy remains the gold standard for the diagnosis of GCA. CT and magnetic resonance angiography can be used to demonstrate large vessel involvement. 6 Ultrasonography and PET-CT are also being evaluated as possible diagnostic tools, but are not yet reliable testing modalities.