ASOPRSFall Scientific SymposiumSyllabus
186
T31
Final Diagnosis inHeadachePatients FollowingTemporal ArteryBiopsy
MarieSomogyi, SarahHale, DavidYoo, YasminShayesteh. Ophthalmology, LoyolaUniversityMedical Center,Maywood, IL,
UnitedStates
Introduction:
Giant cell arteritis (GCA) is a diagnosismade based on a combination of signs, symptoms and laboratory evidence
(1).Temporal artery biopsy is the gold standard for the diagnosis of GCA and a referral for biopsy is commonly encountered entity
in oculoplastic surgery practice (2). Our review investigates the final diagnosis and clinical course of headache patients undergoing
temporal artery biopsywith the suspicion of giant cell arteritis (GCA).To our knowledge, this series of 143 patients is the largest study
to date evaluating the final diagnosis in temporal artery biopsy patients from a single institution.
Methods:
Retrospective chart review of 143 patientswho underwent a temporal artery biopsy from January 2006 toApril 2014 by
vascular surgery, plastic surgery and oculoplastic surgery at our institution.These patientswere identified using the CPT code 37609.
Results:
Of 143 patients, 15 had positive biopsies (10.5%) and 128 had negative biopsies.Among the patientswith negative
biopsies, 41 patients (28.7%) ultimatelywere given the diagnosis of a benign headache. Biopsy-negativeGCAwas diagnosed
when theAmericanCollege of Rheumatology classification (7) criteriaweremet, symptoms improvedwithin 3 days of corticosteroid
therapy and no other diagnosis relevant to the patient’s presenting symptomswas diagnosed. 30 patients (20.9%) were ultimately
diagnosedwith biopsy-negativeGCA. Of the remaining negative biopsies, 7 (4.9%) were found to have non-arteritic anterior
ischemic optic neuropathy, 3 (2.1%) had isolated polymyalgia rheumatic, 3 (2.1%) with systemic vasculitis, 3 (2.1%) with acute
angle closure, 3 (2.1%) with hypertensive urgency, 2 (1.4%) with posterior ischemic optic neuropathy, and 2 (1.4%) with
granulomatosiswith polyangiitis.
Conclusions:
Although only 15 patients (10.5%) had positive temporal artery biopsies, a total of 45 patients (31.5%) were ultimately
treated for giant cell arteritis. Despite that themajority of patients (41 patients or 28.7%) undergoing temporal artery biopsywere
diagnosedwith benign headache, it is important to consider other vision and life threatening entitieswhen presentedwith a patient
with suspectedGCA.
References:
Villa-ForteA. “Giant cell arteritis: Suspect it, treat it promptly.”Cleve Clin JMed. 2011Apr;78(4):265-70.
Jennette JC, Falk RJ.The role of pathology in the diagnosis of systemic vasculitis.Clin Exp Rheumatol 2007; 25 (Suppl. 44):S52-6.
HedgesTR, Gieger GL,Albert DM:The clinical value of negative temporal artery biopsy specimens. ArchOphthalmol 1983;
101: 1251-4.
RothAM,Milsow L, Keltner JL:The ultimate diagnoses of patients undergoing temporal artery biopsies. ArchOphthalmol 1984;
102: 901-3.
ChmelewskiWL,McKnight KM,Agudelo CA,Wise CM: Presenting features and outcome in patients undergoing temporal artery
biopsy. Arch InternMed 1992; 152: 1690-5.
Breuer GS, Nesher R, Nesher G. Negative temporal artery biopsies: eventual diagnoses and features of patientswith biopsy-negative
giant cell arteritis compared to patientswithout arteritis.Clin Exp Rheumatol. 2008Nov-Dec;26(6):1103-6.
Hunder GG, et al.TheAmericanCollege of Rheumatology 1990 criteria for the classification of giant cell arteritis.Arthritis Rheum
1990;33:1122-8
DetailedProgram
—Thursday,October 16, 2014
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