آقـای 80 سـالـه CC : درد سمت چپ سر و تاری دید چشم چپ مشکل بیمار از یک هفته قبل از بستری با درد شدید سمت چپ سر در ناحیه گیجگاهی شروع شده است – تهوع و استفراغ.

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آقـای 80 سـالـه CC : درد سمت چپ سر و تاری دید چشم چپ مشکل بیمار از یک هفته قبل از بستری با درد شدید سمت چپ سر در ناحیه گیجگاهی شروع شده است – تهوع و استفراغ نداشته است درد شدید و مداوم بوده و طی یک هفته بهبودی نداشته است - از 3 روز قبل تاری دید چشم چپ شروع شده که شدت پیدا کرده است بطوریکه قادر به دیدن نیست بیمار توسط چشم پزشک ارجاع شده است. بیمار درد فک موقع جویدن و صحبت کردن دارد. PMH : HTN+ عمل جراحی کاتاراکت طی یک ماه اخیر ( چشم راست ) معاینه سیستمیک : نرمال BP =140/90 معاینه نورولوژی : بیمار هوشیار است نسبتاً اورینته ، تکلم نرمال معاینه کرانیال : ته چشم چپ ادماتو، حرکات چشم نرمال، مردمک ها دو طرفه mm3 و کمی نامنظم ( جراحی ) و پاسخ به نور چپ ضعیف ، بقیه اعصاب کرانیال نرمال. معاینه حرکتی - حسی - تعادلی : نرمال - تندرنس در ناحیه تمپورال چپ - نبض عروق ناحیه تمپورال دو طرفه لمس می شد سمت راست واضح تر بود. CT مغز : کمی آتروفی کورتیکال

G eneral Considerations - Quality. - Severity - Location - Duration - Time Course - Exacerbate &Relieve Factors

Pain-Sensitive Cranial Structures 1-Skin(Subcutaneos Tissue-Muscles-Ext.Arteries an Periosteous) 2-Structures of eye/ear/Nasal Cavity and Sinus 3-Intra cranial Venous Sinus. 4-Dure at skull Base and Arteries (ACA/MCA/ICA) 5-Middle Meningeal and Sup.Temporal Arteries 6-Optic/Oculomotor/Trigeminal/glossopharyngeal

Headache Symptoms That Suggest a Serious Underlying Disorder “worst” headache ever- first servere headache- subacute worsening over days or weeks- abnormal neurologic examination- fever or unexplained systemic signs- vomiting that precedes headache - pain induced by bending. Lifting. Cough- pain that disturbs sleep or presents immediately upon awakening known systemic illness- -onset after age 55 -pain associated with local tenderness.e.g. region of temporal artery

Localization&Diagnosis -Local Tenderness -Pulsnessless -Blurred Vision -Left Papill edema

Clinical diagnosis Temporal Arteritis

آزمایشات : Lab TEST CBC: ANA: 0.24 BS: 84 WBC: 11.4 C -ANCA: 1.1 BUN: 52 RBC: 3.79 P -ANCA: 1.3 Cr: 1.18 Hb: 11.1 C 3 :112 C 4 :23.7 ERS: 97 HCT: 33.3 CH 50 : 87 anti.dsDNA= 4.4 Alpha-1 Glubulin=NI- ( مختصری بالاتر ) -Alpha-2 Glubulin=15.4 RF=Neg

Clinical Symptoms -symptoms result from inflamation of medum and larg Arteries -headache 72% -polymyalgia rheumatrica 58% -jaw claudication 40% -amaurosis fugax /TIA-7-10% - Limb Claudication -ophthalmoplegia -Neuropathy -Vertigo& unilateral hearing loss - confusional state -Myelopathy