02 October 2008

Temporal ateritis

The upside to job shadowing in the ER isn't just face time with a physician, it is also the chance to see patients through to diagnosis and a better idea what is actually wrong with them. I had a chance to see an unusual case resulting in a diagnosis of temporal arteritis, something I had never heard of because you can't really diagnose it in the field, but it is interesting anyway. The doc I was with said this is only the second time in his career he has ever actually found it, despite the hundreds or thousand of times he's looked for it.

Patient presented with a throbbing headache on his L temporal region, painful to palpation, some nausea and double vision, negative on stroke scale (weakness to one side), alert and oriented, complaining about being utterly unable to sleep due to the pain. Recent ultrasound to carotid arteries showed no evidence of blockage. On exam, it wasn't the usual side-to-side double vision, but rather an up and down double vision. Typical presentation would describe more of a "blurred" vision, but not everyone is typical. Laboratory blood work showed an elevated, but not extremely so, sedimentation rate indicating increased inflammation. Consultation with neurology confirmed the suspected diagnosis and treatment plan of the ER doc. Patient was given a steroid dose to go and a follow up for temporal artery biopsy.

Temporal arteritis: http://www.nlm.nih.gov/medlineplus/ency/article/000448.htm
SED rate: http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm

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