Temporal Arteritis and Fever: Report of a Case and a Clinical Reanalysis of 360 Cases

Hu, Zhiping; Yang, Qidong; Zheng, Shan; Tang, Jianguang; Lu, Wei; Xu, Ning; Shong, Xingwang; Jang, Bo Hyun

doi:10.1177/000331970005101108

Cited by 14 publications

(13 citation statements)

References 10 publications

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“…Transient ischemic attack, cerebral infarction, and cerebral hemorrhage may all occur. The frequency of TIA/stroke in temporal artery biopsy-proven disease varies from 3% to 7% (Caselli et al, 1988;Hu et al, 2000).…”

Section: Inflammatory Conditions Associated With Strokementioning

confidence: 99%

Inflammation and Infection in Clinical Stroke

Emsley

Tyrrell

2002

J Cereb Blood Flow Metab

202

126

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Summary:Stroke has enormous clinical, social, and economic implications, and demands a significant effort from both basic and clinical science in the search for successful therapies. Atherosclerosis, the pathologic process underlying most coronary artery disease and the majority of ischemic stroke in humans, is an inflammatory process. Complex interactions occur between the classic risk factors for atherosclerosis and its clinical consequences. These interactions appear to involve inflammatory mechanisms both in the periphery and in the CNS. Central nervous system inflammation is important in the pathophysiologic processes occurring after the onset of cerebral ischemia in ischemic stroke, subarachnoid hemorrhage, and head injury. In addition, inflammation in the CNS or in the periphery may be a risk factor for the initial development of cerebral ischemia. Peripheral infection and inflammatory processes are likely to be important in this respect. Thus, it appears that inflammation may be important both before, in predisposing to a stroke, and afterwards, where it is important in the mechanisms of cerebral injury and repair. Inflammation is mediated by both molecular components, including cytokines, and cellular components, such as leukocytes and microglia, many of which possess pro-and/or antiinflammatory properties, with harmful or beneficial effects. Classic acute-phase reactants and body temperature are also modified in stroke, and may be useful in the prediction of events, outcome, and as therapeutic targets. New imaging techniques are important clinically because they facilitate in vivo dynamic evaluation of tissue damage in relation to outcome. Inflammatory conditions such as giant cell arteritis and systemic lupus erythematosus predispose to stroke, as do a range of acute and chronic infections, principally respiratory. Diverse mechanisms have been proposed to account for inflammation and infection-associated stroke, ranging from classic risk factors to disturbances of the immune and coagulation systems. Considerable opportunities therefore exist for the development of novel therapies. It seems likely that drugs currently used in the treatment of stroke, such as aspirin, statins, and modulators of the renin-angiotensin-aldosterone system, act at least partly via antiinflammatory mechanisms. Newer approaches have included antimicrobial and antileukocyte strategies. One of the most promising avenues may be the use of cytokine antagonism, for example, interleukin-1 receptor antagonist.

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Section: Inflammatory Conditions Associated With Strokementioning

confidence: 99%

Inflammation and Infection in Clinical Stroke

Emsley

Tyrrell

2002

J Cereb Blood Flow Metab

202

126

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“…The arterial lesion can lead to stenosis, occlusion and ischemic infarction [3,4,5,6,7,8]. A temporal artery biopsy showing mononuclear cell and granulomatous inflammation, usually with multinucleated giant cells, is a basic diagnostic method [1, 3, 9, 10]. …”

Section: Introductionmentioning

confidence: 99%

“…The superficial temporal, vertebral, ophthalmic and posterior ciliary arteries are more often involved than the external and internal carotid arteries, while involvement of the intracranial arteries is rarely seen [3,10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

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Giant Cell Arteritis as a Cause of First-Ever Stroke

2007

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The aims of this study were to assess how frequently giant cell arteritis (GCA) was a cause of first-ever stroke in 4,086 patients in the Lausanne Stroke Registry and to determine the risk factors, patterns, latency and current therapy at onset in patients with GCA plus stroke. GCA was recognized using the criteria of the American College of Rheumatology. We report on 6 patients (0.15%) with a histologically proven diagnosis of temporal arteritis and clinical and neuroradiological evidence of cerebral ischemia. The CT and MRI scans showed lacunar infarction in 3 patients, territorial infarction in 2 and were normal in 1. Stroke latency ranged from 0 to 2 months. All patients suffered from headache. We conclude that stroke is a rare, but dangerous, complication of GCA and that a combination of antiplatelet drugs and corticosteroids may be advisable for preventing stroke occurrence.

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“…Physicians may be rushed to reach a probable final diagnosis even if it is inaccurate and may be unsupported by laboratory investigations and imaging techniques. Patients usually improve with symptomatic treatment, and get discharged as cured cases [25]. The underlying cause of infectious -autoimmune and neoplastic diseases -did not differ substantially from those reported in similar studies conducted in Egypt [23] or other surveyed countries [15,16,18,19].…”

Section: Discussionmentioning

confidence: 63%

Clinico-epidemiological profile of fever of unknown origin in an Egyptian setting: A hospital-based study (2009–2010)

Kabapy

Kotkat

Shatat

et al. 2016

J Infect Dev Ctries

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Introduction: Fever of unknown origin (FUO) is one of the most challenging diagnostic dilemmas in the field of infectious diseases and tropical medicine. Clinicians should use the frequency distribution of disorders causing FUO to guide their diagnostic approach in patients with prolonged, unexplained fevers meeting the definition of FUO. Methodology: The present study was undertaken to examine the etiologies, clinico-epidemiologic profile, and prognosis of classical FUO in patients reporting to the Alexandria Fever Hospital in Egypt. Records of 979 patients admitted to the fever hospital (from January 2009 to January 2010) and diagnosed as having FUO were examined carefully. FUO was defined as three outpatient visits or three days in the hospital without elucidation of cause of fever. Results: A total of 979 cases (57.0% males and 43.0% females), with ages ranging from 0.2 to 90 years, were investigated. The mean duration of fever before hospitalization was 31 ± 10 days. The etiology of FUO was delineated in 97% of cases, and only 3% remained undiagnosed. Diagnoses were grouped into five major categories. Infectious causes of FUO were strongly associated with better outcome (73.7% improved). Smoking, contact with animals or birds, drug addiction, and HIV seropositivity were important risk factors associated with infections. Conclusions: Infections are the most common cause of FUO, followed by collagen vascular diseases, in our region. A three-step diagnostic work-up approach is recommended to be applied in Egypt in order to improve the quality of medical service provided to FUO patients.

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Temporal Arteritis and Fever: Report of a Case and a Clinical Reanalysis of 360 Cases

Cited by 14 publications

References 10 publications

Inflammation and Infection in Clinical Stroke

Inflammation and Infection in Clinical Stroke

Giant Cell Arteritis as a Cause of First-Ever Stroke

Clinico-epidemiological profile of fever of unknown origin in an Egyptian setting: A hospital-based study (2009–2010)

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