65 year Old Female Present With Right Temporal Headache

A 65 year old female presents with sever, intermittent, right temporal headache, fever, blurred vision in her right eye and pain in her jaw when chewing. She was suspected to have Temporal arteritis (giant cell arteritis ) and the biopsy of the temporal artery was done. The pathology picture is shown below:

H & E staining of a medium-sized artery with giant cell arteritis. Note thickening of the media and intima with inflammatory cells ( appearing as blue dots)


Case Discussion:

GIANT CELL ARTERITIS :

Giant cell arteritis is the inflammation of the arteries specially affecting the arteries of the temple. This is the reason it is also known as temporal arteritis.

• Giant cell arteritis frequently causes headache, jaw pain and blurred or double vision. 
• Blindness and less often stroke are serious complications of this disease,
• Prompt treatment of giant cell arteritis is necessary to prevent tissue damage and loss of vision.
• Corticosteroids mostly help in control of symptoms and preventing complications and loss of vision. 

Pathophysiology:

• Giant cell arteritis is primarily a disease of cell mediated immunity, which is thought to arise as a maladaptive response to endothelial injury. 
• The primary inflammatory response involves the internal elastic lamina within the media of the arterial wall.
• The release of cytokines within the arterial vessel wall can attract macrophages and multi nucleated giant cells.
• Activated CD4+ helper T cells responds to an antigen presented by macrophages, which gives affected  vessels their characteristic histology.
• Concentric intimal hyperplasia is an important underlying pathologic lesion in Giant cell arteritis. 

Diagnosis:

The gold standard for diagnosing temporal arteritis is biopsy , which involves removing a small part of the temporal vessel and and examining it microscopically for giant cells infiltrating the tissues.