CBL: Temporal Arteritis (Giant Cell Arteritis)

Learning Objectives

• Recognize unilateral temple pain with visual symptoms as concerning for temporal arteritis.
• Understand that GCA is a medical emergency due to risk of blindness.
• Review corticosteroids as first-line treatment.

Vignette

A 65-year-old woman develops two days of left temporal throbbing pain with marked discomfort when opening/closing the mouth, limiting chewing. No prior headache history. She denies visual change or joint pain.

Localization & Neuroanatomy

The differential for unilateral head/temple pain includes migraine, cluster headache, GCA, TMJ disorder, and trigeminal neuralgia. GCA is favored here due to jaw claudication. “Temporal arteritis” is a misnomer: inflammation may involve branches of the external carotid (including the temporal), the ophthalmic and vertebral arteries, and occasionally the axillary/proximal aorta. External carotid involvement can reduce masseter perfusion causing jaw claudication; ophthalmic artery involvement threatens ipsilateral vision.

Diagnosis

Clinical suspicion is driven by history (visual symptoms, jaw pain with chewing). Exam findings vary and may include scalp/temporal artery tenderness or diminished vision from retinal/optic nerve ischemia. Laboratory clues include elevated ESR and/or CRP (and sometimes leukocytosis). Temporal artery biopsy remains the diagnostic gold standard, demonstrating inflammatory infiltrates within the arterial wall.

Treatment

Initiate corticosteroids promptly when GCA is suspected: e.g., prednisone ~60 mg daily for ~1 week with taper, or IV methylprednisolone 1 g daily for 3 days in vision-threatening disease, followed by taper. Analgesics may relieve pain but do not prevent ischemic complications. Rare steroid-refractory cases may require additional immunosuppression (e.g., cyclophosphamide).

Teaching Points

• Jaw claudication and new unilateral temple pain in older adults warrant urgent evaluation.
• Visual symptoms signal ophthalmic artery involvement and risk of permanent vision loss.
• Start steroids when suspicion is high—do not delay for biopsy scheduling.
• Temporal artery biopsy confirms the diagnosis and guides long-term management.

References

1. Module adapted from provided teaching text on temporal (giant cell) arteritis, focusing on jaw claudication, vision risk, diagnostic approach, and steroid therapy.