DOCSLIB.ORG

Muscarinic Toxidrome

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Muscarinic Toxidrome 01/29/2014 Lyte Notes Diagnoses Associations Causes Book of Commons Basic Training Killer Foils Complications Paul de Saint Victor M.D., F.A.C.E.P., M.H.A., C.P.E., F.I.M. Associate Director, Emergency Medicine Residency Program St Vincent Mercy Medical Center Assistant Clinical Professor Department of Surgery University of Toledo, College of Medicine Toledo, Ohio Friday, February 7 Muscarinic Toxidrome Excess acetylcholine (ACh) at muscarinic parasympathetic end organ receptors • Diarrhea D • Urination U • Miosis M • Bradycardia, B • Bronchorrhea, Bronchospasm B E • Emesis L • Lacrimation S •2 Salivation, sweating, Secretion Nicotinic Toxidrome Excess ACh at central autonomic receptors Can be mixed sympathetic and parasympathetic presentation MTWHFS (days of the week) • Mydriasis More severe toxicity: - seizures • Tachycardia - respiratory depression • Weakness - hyperthermia • Hypertension, Hyperglycemia • Fasciculation No specific antidote Supportive care • Seizures Benzos 1 01/29/2014 www.ohacep.org/emrlectures Trauma in Pregnancy and Fetal Death • The most common cause of fetal death in trauma is maternal shock and death. • When the mother survives, abruption is the next leading cause of fetal mortality followed by uterine rupture Match the following red eyes with the diagnosis •EKC (epidemic keratoconjunctivitis) With preauricularHerpes Zoster adenopathy Ophthalmicus With discharge and a cough •Uveitis Painful with mild mucoserous •Herpes simplex infection discharge for 5 d then spread •UV keratitis With cobblestone papillae under •Pseudomonas upper lid •Glaucoma With hypopeon in contact wearer •Iritis After eye surgery •Endophthalmitis With diffuse punctate keratopathy •Viral conjunctivitis With cup:disc ratioHutchinson > 1:2 sign •Allergic conjuncitivitis Dendridic pattern (dumbells) •Chlamydia Cells in the vitreous cavity Ciliary flush, flare in anterior chamber, •GC consensual photophobia 2 01/29/2014 AMS, Resp Alk, Toxidromes Serotonin Met Acid, tinnitus, hyperpnea, diaphoresis toxidrome Agitation, mydriasis, diphoresis, tachy, HTN, Opioid toxidrome hyperthermia, normal BS CNS depression, Cholinergic miosis, resp depression toxidrome AMS, incr muscle tone, hypereflexia, hypertherm Sympathomimetic Sal, Lacr, urination, N/V, WET/BS+ toxidrome diaphoresis, diarrhea, DRY/no BS muscle fasciculation, Anticholinergic bronchorhea, weakness toxidrome AMS, mydriasis, dry mm & skin, urinary retention, Salicylate BS, hyperthermia toxidrome Sudden Loss of Vision Associ ations Pale retina, cherry • Central retinal artery occlusion red spot squashed tomatoes • Central retinal vein occlusion Blood and thunder Sand dunes, flashes of light, floaters , • Retinal detachment lowering curtain, visual field defect 3Fs • Temporal arteritis Polymyalgia rheumatica, 50, CRP, prednisone, blindness, jaw claudication • Multiple sclerosis Optic neuritis, Bilateral internuclear ophthalmoplegia, red desaturation test • Diabetic with visual floaters, loss of red Vitreous hemorrhage reflex, with/without retinal detachment • Amaurosis Fugax Ocular TIA 3 01/29/2014 Because the optic nerve is sensitive to red, when it is damaged, the affected eye sees red colors as washed out pink-orange color. Posterior Vitreous Detachment • Very common problem in the elderly (75% of patients > 65 yo) • Floaters, Flashes of light, cobwebs • May be difficult to differentiate from retinal detachment • Occasionally associated with vitreous hemorrhage (significant visual impairment) which usually resolves spontaneously • Rarely PVD is associated with retinal tears with subsequent retinal detachment A well appearing 38 yo male presents with a 5 day history of diarrhea. PMHx: HTN, smoker. Which of the following is the management of choice? a. IV fluids, laboratory tests, empiric antibiotics b. Oral rehydration, laboratory tests, empiric antibiotics c. IV fluids, imaging, empiric antibiotics d. Oral rehydration and symptomatic outpatient therapy e. Oral rehydration, ultrasound evaluation, stool cultures 4 01/29/2014 Pseudomembranous colitis Seizing pt w diarrhea Toxin producing C diff Fever, toxic, profuse diarrhea Diarrhea w anxiety and Stop Abx, No antidiarrheal heat intolerance Vanco, Metronidazole Diarrhea w paresthesias Legionella Pneumonia and reverse temperature sensation Shigellosis, Theo Tox Elderly pt with bloody diarrhea and abd POOP Arsenic Poisoning Diarrhea, pet turtle or eggs, Sickle cell pts get septic Ciguatera Diarrhea , crampy abd pain, fever, antecedent Salmonella Hx of Abiotic use Diarrhea c Pneumonia Thyrotoxicosis Cholera like diarrhea Mesenteric ischemia All of the following are intrinsic (Contact Activation Pathway) factors of the clotting cascade EXCEPT: • Factor 8 • Factor 9 • Factor 10 • Factor 11 • Factor 12 The Clotting Cascade How it works (in a minute) Tissue Activation Contact Activation Pathway Pathway Extrinsic IN trinsic On 9/11 we Warfarin, INR (PT) were Contacted Heparin , PTT Vit K by outsiders Protamine zinc VII 8-9-11 -12 3, 4, 6 are out 1, 2, 5, 10, 13 Common pathway Vit K dependent factors: II, VII, IX, X 5 01/29/2014 Hematology: Match the Following a. Factors I, II, V, 1. CAP Factors (intrinsic) X, XII 2. Common pathway b. II, VII, IX, X factors c. Factors 9-11 and 3. TAP factors (extrinsic) 8 and 12 4. Vitamin K d. Factors VII dependent factors 2 – 7yo appears ill, dysphagia Sore Throat drooling , distress, muffled Retropharyngeal voice, PE findings except for high fever normal, pain hyoid abscess 6 mo – 3 yo, URI that Bacterial worsens, worse at night, mildly ill, barky cough, Tracheitis stridor, dyspnea, subglottic inflammation, viral Peritonsilar Severe croup pt not abscess responding to racemic epi, pus from ET tube Croup 6mo – 3yo (<4yo) severe airway obstruction, retropharyngeal lymph nodes, dysphagia, ill appearing tripod, muffled voice Epiglottitis > 8 yo, dysphagia, Peds: systemic trouble swallowing, OR for direct exam trismus, deviated uvula Adult: localized Diarrheal disease: Match ’em Looks like appendicitis Vibrio • RLQ pain, little diarrhea Vulnificus • Camper, gay, flatulence Invasive dz of terminal ileum • Shellfish, alcoholic incr Yersinia and cecum – morbidity mortality MC in children Scombroid • Liver cysts • Tuna, (looks like allergic Rx ), Amebiasis peppery taste, facial flushing, palp, abd cramps Giardia 6 01/29/2014 Peritonsillar Abscess • Polymicrobial infections are the rule • Fusopbacterium • GABH strep • Streptococcus • Staphylococcus • Numerous anaerobes • Rx • Needle aspiration + antibiotics Withdrawal Syndrome • Clinical Presentation • Mydriasis • Tachycardia looks sympathomimetic • Hypertension • Diarrhea these indicate withdrawal • Hallucinations Alcoholics drink cheap • Piloerection D-CHEaPLY • Lacrimation • Crampy abdominal pain • Yawning • Seizures – only EtOH, BZ, barb, propoxyphene 7 01/29/2014 Since the radius and ulna have adjacent joints at both ends, a fracture of the shaft of one with significant angulation implies fracture or dislocation of the other. This X-ray depicts which type of fracture? a. Fitch's b. Galeazzi c. Smith's d. Monteggia's e. Colle's Galeazzi - Montaggia - radius fracture • Galeazzi: -distal radio-ulnar joint disruption -distal deformity GR OUND -ulnar nerve ? injury • Monteggia - ulnar fracture -proximal radial head dislocation -elbow deformity -radial nerve ? injury 8 01/29/2014 Monteggia fracture • Apex of ulnar fracture points in direction of radial head dislocation (often missed on x- ray interp) • ORIF required • Galiazzi (reverse Montegia): fracture distal third of radius (G-closer to the Ground) associated with a distal radioulnar joint dislocation Galeazzi - GR ound Ulnar dislocation easily missed 9 01/29/2014 A 28yo male playing soccer suffers this injury during the game. Your next best step is… a. Order an X-ray of the other ankle b. Order an MRI of the same side knee c. Consult orthopedics d. Discharge the patient home in weight bearing posterior splint and crutches A 28yo male playing soccer suffers this injury during the game. Your next best step is… a. Order an X-ray of the other ankle b. Order an X-rayMRI of the same side knee c. Consult orthopedics d. Discharge the patient home in weight bearing posterior splint and crutches Stress X-rays of the ankle is an important step because Maisonneuve fracture puts the ankle mortise joint at extreme risk of instability 10 01/29/2014 Maisonneuve Fracture Associations • Proximal fibular fracture • Deltoid ligament disruption • and ankle joint instability • (stress views of the ankle) • Peroneal nerve injury • Motor: foot dorsiflexion • Sensory: dorsum of foot • With deep peroneal n injury • only: sensory dorsum between • big toe and second toes • May get Maisonneuve with bad ankle sprain only so must look for fibular fracture 11 01/29/2014 A 47yo male involved in MVA. He presents to your ED, severely hypotensive, tachycardic. His GCS is 13. His C-spine, CXR and pelvis X-rays are all negative. His monitor strip is shown. The most likely cause of his hypotension is… a. Cord injury b. Cardiac tamponade c. Pelvic vessel rupture d. Long bone fracture bleeding e. Acute myocardial infarction A 47yo male involved in MVA. He presents to your ED, severely hypotensive, tachycardic. His GCS is 13. His C-spine, CXR and pelvis X-rays are all negative. His monitor strip is shown. The most likely cause of his hypotension is… a. Cord injury b. Cardiac tamponade c. Pelvic vessel rupture d. Long bone fracture bleeding e. Acute myocardial infarction Persistent hypotension in a multiple trauma patient with normal pelvis and chest
Load more

Recommended publications
  • Vasculitis: Pearls for Early Diagnosis and Treatment of Giant Cell Arteritis
    Vasculitis: Pearls for early diagnosis and treatment of Giant Cell Arteritis Mary Beth Humphrey, MD, PhD Professor of Medicine McEldowney Chair of Immunology [email protected] Office Phone: 405 271-8001 ext 35290 October 2019 Relevant Disclosure and Resolution Under Accreditation Council for Continuing Medical Education guidelines disclosure must be made regarding relevant financial relationships with commercial interests within the last 12 months. Mary Beth Humphrey I have no relevant financial relationships or affiliations with commercial interests to disclose. Experimental or Off-Label Drug/Therapy/Device Disclosure I will be discussing experimental or off-label drugs, therapies and/or devices that have not been approved by the FDA. Objectives • To recognize early signs of vasculitis. • To discuss Tocilizumab (IL-6 inhibitor) as a new treatment option for temporal arteritis. • To recognize complications of vasculitis and therapies. Professional Practice Gap Gap 1: Application of imaging recommendations in large vessel vasculitis Gap 2: Application of tocilizimab in treatment of giant cell vasculitis Cranial Symptoms Aortic Vision loss Aneurysm GCA Arm PMR Claudication FUO Which is not a risk factor or temporal arteritis? A. Smoking B. Female sex C. Diabetes D. Northern European ancestry E. Age Which is not a risk factor or temporal arteritis? A. Smoking B. Female sex C. Diabetes D. Northern European ancestry E. Age Giant Cell Arteritis • Most common form of systemic vasculitis in adults – Incidence: ~ 1/5,000 persons > 50 yrs/year – Lifetime risk: 1.0% (F) 0.5% (M) • Cause: unknown At risk: Women (80%) > men (20%) Northern European ancestry>>>AA>Hispanics Age: average age at onset ~73 years Smoking: 6x increased risk Kermani TA, et al Ann Rheum Dis.
    [Show full text]
  • Pattern of Arterial Involvement Ofthe
    368 BritishJournal ofOphthalmology, 1991, 75, 368-371 CASE REPORTS Br J Ophthalmol: first published as 10.1136/bjo.75.6.368 on 1 June 1991. Downloaded from Pattern of arterial involvement of the head, neck, and eyes in giant cell arteritis: three case reports Z Butt, J F Cullen, E Mutlukan Abstract arteries at necropsy showed characteristic The findings oftwo post-mortem examinations changes ofGCA (see below). and one CT scan ofpatients with biopsy proved Post-mortenfindings. Macroscopically the main giant cell arteritis (GCA) are presented. The arteries at the base ofthe brain were virtually free presence or absence of intracranial involve- from atheroma, but a plug ofrather firm clot was ment in GCA is discussed. present in the stump ofthe right internal carotid. The circle of Willis was normally constituted. Several haemorrhagic infarcts were noted in the Giant cell arteritis (GCA) is rarely fatal, and cerebrum (frontal, parietal, temporal, and references to the condition in post-mortem occipital lobes) and cerebellum. Microscopic material are uncommon.'-16 However, this may examination confirmed that these were be related to non-recognition of a fatal outcome very recent, practically terminal, infarcts. in patients with GCA and because post-mortem Occasionally small meningeal arteries overlying examinations of elderly patients dying from the cortical infarcts were noted to contain recent vascular disorders are not routinely carried out. thrombus, but in none of the sections was there GCA may be concealed among the cases diag- evidence ofgiant cell arteritis. nosed as ischaemic catastrophes due to arterio- Sections of the temporal, ophthalmic, verte- sclerosis. " bral, internal carotid (in neck), external carotid, Patients suffering from GCA have a range of left common carotid, and coronary arteries symptoms including headache, jaw claudication, showed changes typical of giant cell arteritis.
    [Show full text]
  • Giant Cell Arteritis Misdiagnosed As Temporomandibular Disorder: a Case Report and Review of the Literature
    360_Reiter.qxp 10/14/09 3:17 PM Page 360 Giant Cell Arteritis Misdiagnosed as Temporomandibular Disorder: A Case Report and Review of the Literature Shoshana Reiter, DMD Giant cell arteritis (GCA) is a systemic vasculitis involving medium Teacher and large-sized arteries, most commonly the extracranial branches Department of Oral Rehabilitation of the carotid artery. Early diagnosis and treatment are essential to avoid severe complications. This article reports on a GCA case Ephraim Winocur, DMD and discusses how the orofacial manifestations of GCA can lead to Lecturer misdiagnosis of GCA as temporomandibular disorder. GCA Department of Oral Rehabilitation should be included in the differential diagnosis of orofacial pain in Carole Goldsmith, DMD the elderly based on the knowledge of related signs and symptoms, Instructor mainly jaw claudication, hard end-feel limitation of range of Department of Oral Rehabilitation motion, and temporal headache. J OROFAC PAIN 2009;23:360–365 Alona Emodi-Perlman, DMD Key words: Giant cell arteritis, jaw claudication, Teacher temporomandibular disorders, trismus Department of Oral Rehabilitation Meir Gorsky, DMD Professor Department of Oral Pathology and Oral iant cell arteritis (GCA) is a systemic vasculitis involving Medicine the large and medium-sized vessels, particularly the extracranial branches of the carotid artery. It is more com- The Maurice and Gabriela Goldschleger G School of Dental Medicine mon in women (M:F ratio 2:5) and usually affects patients older 1 Tel Aviv University, Israel than 50 years with an increased risk with age. The highest preva- lence of GCA has been reported in Scandinavian populations and Correspondence to: in those with a strong Scandinavian ethnic background.2 Dr.
    [Show full text]
  • Arterial-Embolic Strokes and Painless Vision Loss Due to Phase II Aortitis and Giant Cell Arteritis: a Case Report
    Case Report Arterial-embolic Strokes and Painless Vision Loss Due to Phase II Aortitis and Giant Cell Arteritis: A Case Report Kaitlin Endres, BSc* *University of Ottawa, Department of Medicine, Ottawa, Ontario, Canada Omar Anjum, BSc, MD*† †The Ottawa Hospital, Department of Emergency Medicine, Ottawa, Ontario, Canada Nicholas Costain, MD, FRCPC*† Section Editor: Scott Goldstein, MD Submission history: Submitted December 11, 2020; Revision received February 3, 2021; Accepted February 9, 2021 Electronically published April 19, 2021 Full text available through open access at http://escholarship.org/uc/uciem_cpcem DOI: 10.5811/cpcem.2021.2.51143 Introduction: Aortitis refers to abnormal inflammation of the aorta, most commonly caused by giant cell arteritis (GCA). Herein, we present a 57-year-old female with aortitis and arterial-embolic strokes secondary to GCA. Case Report: Our patient presented to the emergency department following an episode of transient, monocular, painless vision loss. Computed tomography angiogram head and neck demonstrated phase II aortitis, and magnetic resonance imaging revealed evidence of arterial-embolic strokes. Conclusion: Cerebrovascular accident is a rare complication of large-vessel vasculitis and can occur due to multiple underlying etiologies including intracranial vasculitis, aortic branch proximal occlusion, or arterial-embolic stroke. [Clin Pract Cases Emerg Med. 2021;5(2):174–177.] Keywords: aortitis; giant cell arteritis; arterial-embolic stroke; painless vision loss. INTRODUCTION periodic night sweats, and generalized subjective weakness, Aortitis refers to abnormal inflammation of the aorta along with a two-month history of intermittent headaches with the most common causes being non-infectious, such as and jaw claudication. For the prior month, she also endorsed giant cell arteritis (GCA) and Takayasu arteritis.1 While transient neurologic deficits, predominantly weakness of the aortitis is rare, it can also be potentially fatal.2 Here we left arm and right leg.
    [Show full text]
  • 16. Vascular Pathology II. 1
    16. Vascular pathology II. VASCULITIS • Vessel wall inflammation is termed vasculitis • Can affect several organs (systemic vasculitis) or a single organ (e.g., skin, CNS) • Pathogenesis: divided into infectious vasculitis (e.g., angioinvasive Aspergillosis) and noninfectious vasculitis Noninfectious systemic vasculitides • Rare • Significant number of cases are diagnosed during autopsy because the symptoms of diseased organs are not considered as consequences of vasculitis • Lethal if untreated Classification according to vessel size Large vessel vasculitis - affects the aorta and its major branches Medium vessel vasculitis - affects the main visceral arteries and their branches Small vessel vasculitis - affects intraparenchymal arteries, arterioles, capillaries, and veins LARGE VESSEL VASCULITIDES TAKAYASU ARTERITIS General features • In females; age less than 40 years • Pathomechanism: T-cell-mediated immune response to vessel wall antigen(s) Morphology • Granulomatous inflammation in the aorta and its proximal branches fibrous thickening of the aortic arch with obliteration of the mouths of the great vessels • Other arteries can also be affected Clinical features • Slowly progressive course • Diminished upper extremity pulses (pulseless disease) ischemic symptoms in the arms • Ocular and neurologic disturbances are common GIANT CELL ARTERITIS General features • In individuals above 50 years of age • Pathomechanism: T-cell-mediated immune response to vessel wall antigen(s) Morphology • Segmental transmural granulomatous inflammation
    [Show full text]
  • Chewing Gum Test for Jaw Claudication in Giant-Cell Arteritis
    The new england journal of medicine lines Committee. Updated guidance for palivizumab prophy- Rates of hospitalization for respiratory syncytial virus infection laxis among infants and young children at increased risk of among children in Medicaid. J Pediatr 2000; 137: 865-70. hospitalization for respiratory syncytial virus infection. Pediat- 4 . Meissner HC. Immunization policy and the importance of rics 2014; 134(2): e620-38. sustainable vaccine pricing. JAMA 2016; 315: 981-2. 3 . Boyce TG, Mellen BG, Mitchel EF Jr, Wright PF, Griffin MR. DOI: 10.1056/NEJMc1601509 Chewing Gum Test for Jaw Claudication in Giant-Cell Arteritis To the Editor: Claudication of the jaw is a A specific symptom with high predictive value for giant-cell arteritis.1 However, a standardized clin- ical test to differentiate claudication from other causes of jaw pain is lacking. We report two cases in which a “chewing gum test” for jaw claudication showed abnormal results. In the first case, a woman, 61 years of age, who had received a clinical diagnosis of giant-cell arteritis 2 years earlier, presented with recurrence of pain in her right jaw, temporal headache, and lethargy after having been weaned from oral prednisolone therapy. The findings from a clinical examination were normal. She was asked to chew B gum at the rate of one chew per second. After 2 minutes of chewing, she reported an ache in her right jaw that was similar to what she had felt 2 years earlier. The pain disappeared with rest but could be reproduced consistently after 2 to 3 minutes of chewing. The dose of her oral prednisolone therapy was increased, and her subjective symptoms resolved.
    [Show full text]
  • Forum Re-Design
    SG IM FO RUM 2016; 39 (11 ) SHARE MORNING REPORT When 50 is Old Michele Fang, MD Dr. Fang is associate professor in the Perelman School of Medicine at the University of Pennsylvania and past president of Midwest SGIM. 56-year-old white female patient orrhage. Medium vessel vasculitis 1 m. Her face is symmetrical. The Ais admitted to the hospital for most typically demonstrates features patient demonstrates left-sided sen - acute onset of painless vision loss. of necrotic lesions and ulcers; nail sory neglect. Strength is 4+/5 in the Her daughter has noticed that the fold infarcts; mononeuritis multiplex; right upper and lower extremity and patient is bumping into objects, but renal infarction; infarction of liver, 0/5 in the left upper and lower ex - the patient denies any problems spleen, or pancreas; myocardial in - tremities. Plantar reflex is extensor with her vision. The patient has a farction; and nasal crusting and si - on the left. There is no clonus. one-year history of anorexia and nusitis. Large vessel vasculitis The patient’s neurological defect upper abdominal pain and a 30- to involves the aorta and its branches is most consistent with Anton’s syn - 40-pound unintentional weight loss. and can lead to symptoms of tempo - drome in which patients deny their Six months prior to admission, the ral headache (temporal arteritis), blindness despite objective evidence patient developed bilateral leg blindness (ophthalmic artery), jaw of visual loss. This typically involves cramps with walking. Evaluation claudication, limb claudication, and confabulation to support the belief demonstrated bilateral peripheral thoracic aortic aneurysms.
    [Show full text]
  • NIH Public Access Author Manuscript Circulation
    NIH Public Access Author Manuscript Circulation. Author manuscript; available in PMC 2009 October 9. NIH-PA Author ManuscriptPublished NIH-PA Author Manuscript in final edited NIH-PA Author Manuscript form as: Circulation. 2008 June 10; 117(23): 3039±3051. doi:10.1161/CIRCULATIONAHA.107.760686. Aortitis Heather L. Gornik, M.D., M.H.S. and Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Medical Director, Non-Invasive Vascular Laboratory Department of Cardiovascular Medicine The Cleveland Clinic Foundation 9500 Euclid Avenue/Desk S60 Cleveland, Ohio 44120 (216) 445-3689 [email protected] Mark A. Creager, M.D.* Professor of Medicine, Harvard Medical School Simon C. Fireman Scholar in Cardiovascular Medicine Director, Vascular Center Brigham and Women's Hospital 75 Francis Street Boston, Massachusetts 02115 (617) 732-5267 [email protected] Keywords Aortitis; vasculitis; giant cell arteritis; Takayasu arteritis; aortic aneurysm Aortitis is the all-encompassing term ascribed to inflammation of the aorta. The most common causes of aortitis are the large vessel vasculitides, giant cell arteritis (GCA) and Takayasu arteritis, although it is also associated with several other rheumatologic diseases. Infectious aortitis is a rare but potentially life-threatening disorder. In some cases, aortitis is an incidental finding at the time of histopathologic examination following surgery for aortic aneurysm. As the clinical presentation of aortitis is highly variable, the cardiovascular clinician must have a high index of suspicion to establish an accurate diagnosis of this disorder in a timely fashion. In this manuscript, we review the pathophysiology, epidemiology, diagnostic approach, and management of aortitis.
    [Show full text]
  • Temporal Headache and Jaw Claudication May Be the Key for the Diagnosis of Giant Cell Arteritis
    Med Oral Patol Oral Cir Bucal. 2018 May 1;23 (3):e290-4. Temporal headache and jaw claudication in giant cell arteritis Journal section: Oral Medicine and Pathology doi:10.4317/medoral.22298 Publication Types: Research http://dx.doi.org/doi:10.4317/medoral.22298 Temporal headache and jaw claudication may be the key for the diagnosis of giant cell arteritis Beatriz Peral-Cagigal 1, Álvaro Pérez-Villar 1, Luis-Miguel Redondo-González 1, Claudia García-Sierra 1, Marina Morante-Silva 1, Beatriz Madrigal-Rubiales 2, Alberto Verrier-Hernández 1 1 Oral and Maxillofacial Surgery Department. Río Hortega Hospital, Valladolid, Spain 2 Pathology Department. Río Hortega Hospital, Valladolid, Spain Correspondence: Servicio Regional de Cirugía Oral y Maxilofacial Hospital Universitario del Río Hortega C/Dulzaina nº 2 47012 Valladolid, Spain Peral-Cagigal B, Pérez-Villar A, Redondo-González LM, García-Sierra [email protected] C, Morante-Silva M, Madrigal-Rubiales B, Verrier-Hernández A. Tempo- ral headache and jaw claudication may be the key for the diagnosis of giant cell arteritis. Med Oral Patol Oral Cir Bucal. 2018 May 1;23 (3):e290-4. http://www.medicinaoral.com/medoralfree01/v23i3/medoralv23i3p290.pdf Received: 26/11/2017 Accepted: 03/02/2018 Article Number: 22298 http://www.medicinaoral.com/ © Medicina Oral S. L. C.I.F. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946 eMail: [email protected] Indexed in: Science Citation Index Expanded Journal Citation Reports Index Medicus, MEDLINE, PubMed Scopus, Embase and Emcare Indice Médico Español Abstract Background: Temporal artery biopsy (TAB) is a surgical procedure with a low positive yield.
    [Show full text]
  • Inflammatory and Infectious Aortic Diseases
    70 Review Article Inflammatory and infectious aortic diseases Amy R. Deipolyi1, Christopher D. Czaplicki2, Rahmi Oklu2 1Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 2Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA Contributions: (I) Concept and design: AR Deipolyi, R Oklu; (II) Administrative support: None; (III) Provision of study materials or patients: CD Czaplicki, R Oklu; (IV) Collection and assembly of data: AR Deipolyi, CD Czaplicki; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Rahmi Oklu, MD, PhD. Division of Interventional Radiology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA. Email: [email protected]. Abstract: Aortitis is aortic inflammation, which can be due to inflammatory or infectious diseases. Left undiagnosed, aortitis can lead to aneurysm formation and rupture, in addition to ischemic compromise of major organs. Infectious aortic diseases include mycotic aneurysm and graft infection; the most common inflammatory diseases are Takayasu’s and giant cell arteritis. We review the epidemiology, etiology, presentation and diagnosis, and treatment of these entities. Keywords: Aortitis; mycotic aneurysm; giant cell arteritis; Takayasu’s arteritis Submitted Aug 06, 2017. Accepted for publication Sep 01, 2017. doi: 10.21037/cdt.2017.09.03 View this article at: http://dx.doi.org/10.21037/cdt.2017.09.03 Introduction aneurysms (2-5). Mycotic aneurysms are more likely to occur in the aorta than other arteries (6-8). Previously, Aortitis, inflammation of the aorta, is most commonly MAs were associated with endocarditis, β-hemolytic group due to large-vessel vasculitides including giant cell and A streptococci, pneumococci, and Haemophilus influenza Takayasu’s arteritis (Table 1) (1).
    [Show full text]
  • Neck Swelling and Airway Narrowing As an Initial Manifestation of Giant Cell Arteritis Zhen Sheng Lim, Colin Sharp ‍ ‍
    Case report BMJ Case Rep: first published as 10.1136/bcr-2020-237743 on 15 March 2021. Downloaded from Neck swelling and airway narrowing as an initial manifestation of giant cell arteritis Zhen Sheng Lim, Colin Sharp Medicine, Launceston General SUMMARY inferoanteriorly to her neck. This was associated Hospital, Launceston, Tasmania, Giant cell arteritis can result in a wide range of with trismus- like sensation and dyspnoea. She Australia symptoms due to the extensive distribution of the denied any recent respiratory illness or dysphagia. external carotid artery. Face and neck swelling and The patient’s medical history included hyperten- Correspondence to trismus are under- recognised features of giant cell sion treated with irbesartan/hydrochlorothiazide, Dr Colin Sharp; colin. sharp@ ths. tas. gov. au arteritis and can present as the initial symptom prior hypercholesterolemia on atorvastatin and osteo- to the development of classical temporal tenderness porosis on denosumab. In addition, she had been Accepted 14 December 2020 and jaw claudication. The lack of awareness of the less taking aspirin for primary prevention of ischaemic common symptoms may result in a late diagnosis of heart disease. There were no medication changes in giant cell arteritis, leading to irreversible vision loss. the preceding 3 years. In this paper, we present a case of neck swelling and During the initial presentation, the patient had airway narrowing as the initial manifestation of giant cell a low-grade temperature of 37.8°C and remained arteritis. haemodynamically stable with a heart rate of 100 bpm, blood pressure of 170/80 mm Hg and an oxygen saturation of 98% on room air.
    [Show full text]
  • Jaw Claudication in Primary Amyloidosis: Unusual Presentation of a Rare Disease CHRISTOPHER H
    Case Report Jaw Claudication in Primary Amyloidosis: Unusual Presentation of a Rare Disease CHRISTOPHER H. CHURCHILL, ANDYABRIL, MURLI KRISHNA, MARK L. CALLMAN, and WILLIAM W. GINSBURG ABSTRACT. We describe 2 patients with temporal artery biopsy-proven amyloidosis presenting with symptoms of jaw claudication, visual disturbance, and proximal muscle stiffness suggestive of giant cell arteritis (GCA) and polymyalgia rheumatica. At the onset of disease, neither patient had other char- acteristic symptoms to suggest primary amyloid. We point out similarities between GCA and primary amyloid that can lead to confusion in diagnosis. (J Rheumatol 2003;30:2283–6) Key Indexing Terms: GIANT CELL ARTERITIS POLYMYALGIA RHEUMATICA PRIMARY AMYLOIDOSIS JAW CLAUDICATION Primary amyloid is a rare disease that characteristically he had been prescribed 10 mg prednisone with no benefit. Within the month presents with findings that include carpal tunnel syndrome, prior to his visit while taking prednisone 10 mg he noted some swelling of the right wrist without symptoms of carpal tunnel syndrome. He also devel- congestive heart failure, nephrotic syndrome, peripheral oped jaw claudication and 2 episodes of diplopia. He had no headache, 1 neuropathy, and orthostatic hypotension . Our 2 patients scalp tenderness, or fever. His history included long-standing hypertension presented with symptoms of jaw claudication and visual and atherosclerotic cardiovascular disease, with 5-vessel bypass surgery in disturbance suggestive of giant cell arteritis (GCA) and had 1998 and a carotid endarterectomy in 1999. polymyalgia rheumatica (PMR)-like symptoms. Both had Examination revealed prominent temporal arteries with normal pulses and no tenderness. Cardiac, pulmonary, and abdominal examination were anemia and an elevated erythrocyte sedimentation rate unremarkable.
    [Show full text]