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Annals of Emergency Medicine – Temporal Arteritis

Mariko Ishimori, MD and Jan Shoenberger, MD
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12:42
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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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04:32

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EM:RAP 2015 May Written Summary 1 MB - PDF

Can patients with temporal arteritis have a normal sed rate? Yes they can.

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Orlando M., M.D. -

The review of GCA was great. I was under the impression that the ESR sensitivity was better. I have a question about the photograph in the written summary notes. Are you sure it depicts a temporal artery? As I look through my Netter's Atlas it appears that the trunk of the TA should be just anterior to the ear. This photo may depict a distal branch of the TA, but it looks so much like a vein to me. Great review anyway.

Jan S. -

Great question! You're absolutely correct that the STA arises just anterior to the ear, but it then gives off branches before it splits into the frontal and parietal branches of the STA. When looking for a clinically prominent or beading temporal artery, we are assessing these distal branches of the superficial temporal artery (frontal is more conspicuous than parietal). By the picture alone, it's difficult to distinguish artery vs vein, but we are assuming the authors confirmed the arterial origin via biopsy. If in doubt, you could use a bedside ultrasound to assess arterial anatomy and flow!

NL -

I had an interesting case a few months ago when someone was clinically diagnosed with Giant Cell /Temporal Arteritis despite a slightly elevated sed rate/crp but WNL. I was involved after they had no response with high dose steroids, and less interactive in the ICU. Ultimately they had HSV encephalitis with normal biopsy. Pt had gcs 4-5, but finally left ICU on day #17 with acyclovir.

Cole S. -

So what is the disposition for patients with suspected temporal arteritis?

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A Totally Mental Month of Education! Full episode audio for MD edition 285:23 min - 332 MB - M4AEM:RAP 2015 May Canadian Edition Canadian 17:44 min - 24 MB - MP3EM:RAP 2015 Peut Résumé en Francais Français 59:38 min - 82 MB - MP3EM:RAP 2015 Mayo Resumen Español Español 74:07 min - 85 MB - MP3EM:RAP 2015 May Aussie Edition Australian 62:22 min - 86 MB - MP3EM:RAP 2015 May MP3 329 MB - ZIPEM:RAP 2015 May Written Summary 1 MB - PDFEM:RAP 2015 May Board Review Answers 415 KB - PDFEM:RAP 2015 May Board Review Questions 416 KB - PDFEM:RAP Español Mayo 2015 1 MB - PDF

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