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Occult temporal arteritis in a 54-year-old man.
MedLine Citation:
PMID:  21135707     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
A 54-year-old white man with a remote history of pars planitis reported transient monocular visual loss (TMVL) in the left eye on standing. The following week he experienced multiple similar episodes. He denied associated systemic symptoms. Initial examination showed old peripheral retinal vascular sheathing and delayed retinal arterial filling time. Complete blood count, erythrocyte sedimentation rate, and MRI studies of the head and neck were normal. One week later, there were multiple cotton wool spots in the posterior pole, a relative afferent pupillary defect, and subtle visual field loss in the left eye. Evaluation for infectious, inflammatory, or embolic etiologies was nonrevealing. Biopsy of the prominent but nontender temporal arteries showed granulomatous inflammation, fragmentation, and duplication of the internal elastic lamina consistent with the temporal arteritis (TA). Radiography and MRI of the chest revealed dilation of the ascending aorta. The patient began treatment with high-dose oral steroids with resolution of his TMVL and retinal cotton wool spots and decrease in the size of the temporal arteries. Our case demonstrates the importance of considering TA in the setting of TMVL, visual loss, cotton wool spots, or dilated nontender temporal arteries in an otherwise asymptomatic patient even with normal inflammatory markers. Long-term follow-up is essential in unusual cases such as this one, given the high risk of ocular and systemic morbidity with TA.
Authors:
Flora Levin; Hermann D Schubert; John C Merriam; Ralph S Blume; Jeffrey G Odel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society     Volume:  31     ISSN:  1536-5166     ISO Abbreviation:  J Neuroophthalmol     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431308     Medline TA:  J Neuroophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  153-4     Citation Subset:  IM    
Affiliation:
Department of Ophthalmology (FL), Yale University, New Haven, Connecticut; and Edward S. Harkness Eye Institute, Columbia University Medical Center (HDS, JCM, RSB, JGO), New York, New York.
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