Topography of the deep temporal arteries and implications for performing safe aesthetic injections

2021 ◽  
Author(s):  
Andreas Nikolis ◽  
Kaitlyn M. Enright ◽  
Theodore Troupis ◽  
Michael Koutsilieris ◽  
Alexander J. Stratigos ◽  
...  
Keyword(s):  
Temporal Arteries

Craniectomy with microvascular flap reconstruction in a patient taking infliximab for vasculitis

2020 ◽  
Vol 13 (12) ◽  
pp. e238614
Author(s):  
Ogonna N Nnamani Silva ◽  
Audrey B Nguyen ◽  
William Y Hoffman
Keyword(s):  
Diabetes Mellitus ◽  
Latissimus Dorsi ◽  
Perioperative Management ◽  
Large Cell ◽  
Evidence Based ◽  
Flap Reconstruction ◽  
Biologic Drugs ◽  
Temporal Arteries ◽  
Immune Mediated ◽  
Microvascular Flap

For patients whose vasculitis is managed with biologic medications, no reports or evidence-based guidance exists regarding the perioperative management of microvascular flaps. We present a case of a 78-year-old patient with Takayasu’s arteritis (TA) and diabetes mellitus who was taking infliximab and underwent wide local excision of squamous cell carcinoma, craniectomy and reconstruction with a latissimus dorsi flap. TA, an immune-mediated large cell vasculitis characterised by granuloma formation, tends to affect larger vessels and aortic branches. The typical localisation of this condition raises concerns about potentially compromised pedicle and recipient vessels (ie, superficial temporal arteries), which could hinder postoperative flap success. Discontinuation of infliximab 4 weeks before surgery and resumption 6 weeks after led to favourable results. This case addresses the gap in the literature concerning stopping and restarting biologic drugs in the perioperative setting and documents a successful course of a microvascular procedure in a patient with vasculitis.

scholarly journals AB0473 “HALO SIGN” IN ULTRASOUND OF TEMPORAL, FACIAL AND AXILLARY ARTERIES: ASSOCIATIONS WITH CLINICAL SYMPTOMATOLOGY AND LABORATORY FINDINGS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1534.2-1535
Author(s):  
G. Evangelatos ◽  
G. E. Fragoulis ◽  
A. Iliopoulos
Keyword(s):  
Vessel Wall ◽  
Vascular Inflammation ◽  
Inflammation Markers ◽  
Laboratory Findings ◽  
Clinical Symptomatology ◽  
Temporal Arteries ◽  
Halo Sign ◽  
Increased Risk ◽  
Us Findings ◽  
Specific Symptoms

Background:Giant cell arteritis (GCA) has two subtypes, the cranial form (“cranial GCA”) and the large-vessel form (“LV-GCA”). GCA can present with “cranial” symptoms (headache, visual symptoms, jaw claudication, scalp tenderness), constitutional symptoms (fever, fatigue), limb claudication and symptoms of polymyalgia rheumatica (PMR) and usually causes increased inflammation markers, anemia and thrombocytosis. Ultrasound (US) of the temporal and axillary arteries has a well-established role in cranial GCA and LV-GCA diagnosis, respectively. However, it is unknown whether specific clinical and laboratory parameters are linked with US findings suggestive of vascular inflammation (“halo” sign).Objectives:The aim of this study was to examine possible association between clinical and laboratory characteristics of the patients and detection of vessel wall inflammation in the US.Methods:Patients ≥50 years old with elevated ESR (≥50mm/h) and/or CRP (≥10mg/L) that presented in our outpatient rheumatology clinics from July 2017 to December 2019 with possible clinical diagnosis of GCA were included. Three groups were compared: Patients with “cranial symptoms” (with or without PMR), patients with PMR symptoms only and patients with increased inflammation markers without specific symptoms indicative of GCA. Temporal arteries and their main branches, as well as facial and axillary arteries were evaluated by US bilaterally for the presence of non-compressible “halo sign” at the vessel wall. Clinical symptomatology and the occurrence of anemia and thrombocytosis were recorded.Results:52 patients were included. 71.2% were females, with a mean±SD age of 71.0±10.0 years. 17 patients had “cranial symptoms” (seven patients with concomitant PMR and ten without), 17 patients had PMR symptoms only, while 18 patients had non-specific symptoms (e.g. fever) (Table 1). Among 17 patients with “cranial symptoms”, 7/7 (100%) with concomitant PMR had a positive temporal US, while only 3 out of 10 (30%) without PMR had a positive temporal US (p<0.01) and US was indeterminate in 2 of them (20%). Collectively, 10/17 (58.8%) of patients with “cranial symptoms” and systemic inflammation had a US examination compatible with GCA. No patient with “cranial symptoms” had a positive US of axillary arteries. No patient with only PMR symptoms, had “halo sign” in temporal and facial arteries, while 3 out of 17 (17.6%) had a positive axillary US. From the 18 patients with elevated ESR/CRP, one had a positive temporal US and another one had a positive axillary US. Regarding specific symptoms, positive temporal US was associated with new headache (p=0.003), vision impairment (p=0.001), jaw claudication (p=0.05), scalp tenderness (p=0.01) and fever (P=0.002), but not with PMR (p=0.317). Thrombocytosis was associated with an increased risk for “halo sign” detection in temporal (p=0.04) and facial (p=0.007) arteries, but not in axilliary arteries (p=0.52).Conclusion:60% of patients with “cranial symptoms” and elevated inflammation markers have US temporal findings indicative of GCA. This is more pronounced in patients with concomitant PMR symptoms and is associated with specific symptomatology. 18% of patients with only PMR symptoms might have LV-GCA, while those with high ESR/CRP without GCA-related symptoms rarely have “halo sign” in US.Disclosure of Interests:None declared

5-Hydroxytryptamine receptor characterizations of human cerebral, middle meningeal and temporal arteries: regional differences

1993 ◽  
Vol 147 (2) ◽  
pp. 141-150 ◽  
Author(s):  
I. JANSEN ◽  
J. OLESEN ◽  
L. EDVINSSON
Keyword(s):  
Regional Differences ◽  
Temporal Arteries

scholarly journals Prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis

Neurology ◽  
2015 ◽  
Vol 84 (19) ◽  
pp. 1948-1955 ◽  
Author(s):  
D. Gilden ◽  
T. White ◽  
N. Khmeleva ◽  
A. Heintzman ◽  
A. Choe ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Arteries

The Psychiatric Aspects of Temporal Arteritis

1952 ◽  
Vol 98 (411) ◽  
pp. 280-286 ◽  
Author(s):  
R. Vereker
Keyword(s):  
Virus Infection ◽  
Giant Cell Arteritis ◽  
Temporal Arteritis ◽  
Giant Cells ◽  
Low Grade ◽  
Internal Elastic Lamina ◽  
Temporal Arteries ◽  
The Media ◽  
Cranial Arteries ◽  
Elastic Lamina

Temporal arteritis, also called giant cell arteritis, or cranial arteritis, was first described in 1932 by Horton and Magath. This syndrome is caused by a reversible inflammation of the cranial arteries, especially the temporal arteries (which are visibly inflamed), causing headache, mental and neurological disturbances as well as general toxic signs, and almost always occurring after the age of fifty-five years.Pathology.—In the arteries involved there is a subacute inflammation of the adventitia and media with focal necrosis of the media, fragmentation and destruction of the internal elastic lamina with gross hypertrophy of the intima, often leading to occlusion of the vessel. In many cases giant cells are found in the media. Besides the cranial arteries other vessels are sometimes involved, e.g., the carotids (Scott and Maxwell 1941; Gilmour 1941), subclavian, coronary and femoral arteries (Cookeet al., 1946), post-auricular (Dick and Freeman 1940).Aetiologyis unknown. There is no evidence of tuberculosis or syphilis. A low-grade bacterial or virus infection of the arteries has been postulated, but repeated bacteriological examinations of the biopsied arteries have failed to isolate any organisms. The predilection which the condition shows for the temporal and cranial arteries is unexplained.

scholarly journals POS0821 THE DIFFERENT SUBTYPES OF GIANT CELL ARTERITIS BY ULTRASOUND: RESULTS FROM A FAST-TRACK CLINIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 664.3-664
Author(s):  
I. Monjo ◽  
E. Fernández-Fernández ◽  
J. Ortega ◽  
E. De Miguel
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Fast Track ◽  
Carotid Arteries ◽  
Imaging Techniques ◽  
Vascular Involvement ◽  
Temporal Arteries ◽  
Halo Sign ◽  
Cranial Vessels ◽  
Large Vessels

Background:Giant cell arteritis (GCA) is a vasculitis that affects the medium and large vessels (LV). Although cranial artery involvement is better known, awareness of the importance of LV involvement is increasing. Imaging techniques currently constitute the basis for the diagnosis of LV-GCA and have improved its diagnosis and prevalence. In recent years, differences in clinical patterns and different inflammatory and etiopathogenic mechanisms of the disease have been suggested. Therefore, improving sensitivity to diagnosis is essential to improve the knowledge and care of our population.Objectives:The aim of this study was to know the prevalence of the different ultrasound patterns of GCA in our area.Methods:Retrospective records of available data were collected from all patients referred to our ACG fast track clinic in the past three years. The clinical and laboratory characteristics were evaluated at the time of referral. All patients underwent an ultrasound scan of cranial vessels (superficial temporal arteries (TA) and their frontal and parietal branches) and large vessels (axillary, subclavian and carotid arteries). The doctor confirmed the GCA diagnosis after at least six months of follow-up. The OMERACT definitions of halo sign with a hypoechoic wall thickness ≥ 0.34 mm were used for TA pathology for the ultrasound diagnosis of GCA and for axillary, subclavian and carotid arteries and homogeneous hypoechoic thicknesses ≥ 1 mm of the arterial wall were applied. Atherosclerosis lesions were evaluated to detect this disease as a possible false positive halo sign. An Esaote Mylab Twice with a 13 MHz probe in BT and 22 MHz for cranial vessels in 2017-2019 and an Esaote Mylab X8plus with a 15 MHz probe for BT and a 24 MHz probe for cranial arteries in 2019-2020 were used by two rheumatologist with long experience in ACG ultrasound.Results:A total of 261 patients (180 women / 81 men) with suspected GCA were evaluated in our fast track clinic. The mean age (± SD) was 76 ± 9.2 years and CRP at diagnosis was 75.7 ± 68.6 mg/L. The time elapsed since the first symptoms was less than 6, 6-12, 12-24 or >24 weeks in 37.5%, 19.9%, 12.3% and 15.7% respectively. Of the 261 cases explored, 160 had GCA, of which 102 were women and 58 men, and had a mean age of 77.21 ± 7.9 years. The ultrasound patterns of GCA were: 71 patients had exclusive involvement of the TA (cranial-GCA), 54 had a mixed pattern with involvement of both TA and LV (mixed-CGA), and 35 had isolated involvement of the LV (LV-GCA). That is, 125 patients had cranial involvement with or without LV involvement and 89 had LV-GCA associated or not with cranial involvement (Figure 1).Figure 1.Ultrasound patters of GCAConclusion:Ultrasound is a useful tool for the screening of GCA and its different subtypes of vascular involvement. The isolated cranial subtype or associated with LV-GCA is the most common (78% of cases), but LV-GCA is also very common (55.6% of cases of GCA) and 21.9% presents as an isolated LV-GCA standard. The LV arteries should be included in the ultrasound examination for suspected GCA.Disclosure of Interests:Irene Monjo Speakers bureau: Roche, Novartis, UCB, Gedeon Richter, Consultant of: Roche, Elisa Fernández-Fernández: None declared, Javier Ortega: None declared, Eugenio de Miguel Speakers bureau: AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi, Paid instructor for: Janssen, Novartis, Roche, Consultant of: AbbVie, Novartis, Pfizer, Galapagos, Grant/research support from: Abbvie, Novartis, Pfizer

The sensitivity of temporal artery biopsy in the detection of giant cell arteritis is independent of tissue length

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S28-S29
Author(s):  
H J Hurley ◽  
P Q Deb
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Average Length ◽  
Statistical Significance ◽  
Temporal Artery ◽  
Temporal Artery Biopsy ◽  
Temporal Arteries ◽  
Biopsy Specimens ◽  
Two Samples ◽  
Left And Right

Abstract Introduction/Objective Giant cell arteritis (GCA) is the most common vasculitis of the elderly, and the most common primary systemic vasculitis overall, with an annual incidence of 200/million. The long term sequelae, namely vision loss and stroke, are permanent and devastating. While GCA is often treated empirically based on clinical presentation, panarteritis on temporal artery biopsy is required for diagnosis. However, these biopsies have the tendency to be falsely negative due to skip lesions, a common feature of GCA. Therefore, we set out to determine whether longer biopsy specimens were more sensitive in the detection of GCA. Methods/Case Report A census of temporal artery biopsies performed with the indication of clinical symptoms of GCA was taken at our institution. The patient age, sex, biopsy laterality, biopsy length, and pathological diagnosis were recorded for each cataloged sample. Statistical significance of difference in biopsy length was tested using an unpaired t-test in R 4.1.0. Results (if a Case Study enter NA) A total of 114 temporal artery specimens were biopsied from 94 different patients with the indication of GCA and assigned a definitive positive or negative diagnosis. Of the 94 patients, 54 were female and 40 were male. Of the total pathological specimens, 11 were positive and 103 were negative. The overall average length of biopsy specimens was 2.13 cm with a standard deviation of 0.65 cm. The average positive biopsy was 2.26 cm long, and the average negative was 2.12 cm, an insignificant difference (0.14 cm, t = 0.7, p = 0.43). In 25 patients, biopsies were taken from both the left and right temporal arteries. Of those patients, 2 were positive for GCA and the remaining 23 were negative. Interestingly, the biopsy result in every case was identical between the left and right samples; we found no instances of pathological evidence of GCA in only one of the two samples from the same patient. Conclusion According to data taken at our institution, there is no indication to lengthen the biopsy requirements from the existing 1.5 cm. However, we have demonstrated evidence that it may be unnecessary to biopsy both temporal arteries in a single patient. Larger studies would be required to confirm our findings.

Prevention of classic migraine headache by digital massage of the superficial temporal arteries during visual aura

1986 ◽  
Vol 19 (5) ◽  
pp. 515-516 ◽  
Author(s):  
Stuart A. Lipton
Keyword(s):  
Migraine Headache ◽  
Visual Aura ◽  
Temporal Arteries

Sumatriptan is a Potent Vasoconstrictor of Human Dural Arteries Via a 5-HT1-Like Receptor

Cephalalgia ◽  
1992 ◽  
Vol 12 (4) ◽  
pp. 202-205 ◽  
Author(s):  
Inger Jansen ◽  
Lars Edvinsson ◽  
Anders Mortensen ◽  
Jes Olesen
Keyword(s):  
Receptor Agonist ◽  
Temporal Arteries ◽  
Low Concentrations ◽  
Meningeal Arteries ◽  
Potent Vasoconstrictor

The action of sumatriptan, putatively a selective 5-HT 1D or 5-HT 1 -like receptor agonist which is effective in the treatment of migraine, has been studied on fresh human dural (middle meningeal) arteries. In low concentrations (10-8 -10-7 M) it was found to be a significantly stronger vasoconstrictor of dural arteries compared to cerebral and temporal arteries. However, its potency was less than that of 5-HT. The sumatriptan-induced vasoconstriction was antagonized by methiothepin (10-9 -10-8 M), but not by ketanserin (10-7 M). The observations suggest that the sumatriptan-induced contraction of the dural artery is mediated via activation of 5-HT 1D or 5-HT 1 -like receptors, whereas it does not appear to activate the 5-HT 2 receptors.

Multi-Vessel Biopsy-Proven Giant Cell Arteritis Involving the Occipital and Temporal Arteries

1997 ◽  
Vol 3 (4) ◽  
pp. 227-229 ◽  
Author(s):  
M. Anthony Albornoz ◽  
Shahid Sharit ◽  
Allen R. Myers
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Arteries
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