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I congratulate Riordan-Eva et al for the article on temporal artery biopsy in the management of giant cell arteritis with neuro-ophthalmic complications. This is an excellent article for residents, ER physicians, Family Practice physicians and Ophthalmologists.
The 3 cases discussed clearly show that patients over the age of 50 presenting with temporary or permanent visual loss or binocular dipl...
The 3 cases discussed clearly show that patients over the age of 50 presenting with temporary or permanent visual loss or binocular diplopia and with or without systemic signs of temporal arteritis must have at least SED rate checked. If the suspicion is high the patient must be started on high dose steroids. We prefer IV solumedrol for the first 3-4 days followed by prednisone by mouth. A Medrol dose pack that is given for 5 days in tapering doses is not adequate.
We perform temporal artery at convenience within 2 weeks. When available we prefer to do frozen section on the affected side. If negative we do the other side. When frozen section is not available we do routine biopsy on the affected side and prefer to wait for the results. We do not do bilateral temporal artery biopsy at the same time.
As mentioned in the article the biopsy should be at least 2-2.5 mm and the pathologist must be adequately trained to interpret temporal artery biopsies. With negative biopsies on both sides provided the above criteria are met we conclude that the patient has no GCA.
(1) Riordan-Eva, P, Landau, K, and O'Day, J. Temporal artery biopsy in the management of giant cell arteritis with neuro-ophthalmic complications. Brit J Ophthalmol 2001 85: 1248-1251.