Temporal arteritis

Horton's syndrome, temporal arteritis or giant cell arteritis - all these designations refer to the same disease and are synonyms.

This pathological change in the body is systemic in nature, bringing a lot of unpleasant minutes and sometimes hours to a person.

Causes of Temporal Arteritis

This pathology is expressed by changes that affect, oddly enough, medium and large blood vessels that are located in close proximity to the carotid artery, while small capillaries are practically not affected. Mostly, such lesions affect individual arteries that supply blood to individual areas of the head. This may be the optic nerve, the vessels supplying the eye or a certain area of the cerebral cortex.

The most severe complication of temporal arteritis is the loss of vision by sick people. Therefore, you should not brush off this pathology, "maybe it will go away on its own." So what are the causes of temporal arteritis, how dangerous is it, and how to stop this problem with the least losses for the human body? We will try to find answers to all these and some other questions in this article.

To date, doctors are unable to clearly voice the causes that can cause the emergence and progression of Horton's syndrome. Experts believe that one of the sources of the disease is an infectious trace of the disease, since in a third of patients who were diagnosed with the disease, antibodies and antigens formed against the background of infectious diseases such as influenza and various forms of hepatitis were found in the blood and mucous tissues of pathologically altered vessels.

Some experts reasonably propose a genetic theory of disease adherence. Based on statistical data, there is reason to believe that this disease predominantly affects representatives of the white race. Quite often, this disease also affects identical twins. If one of the brothers (sisters) has this pathology, then there is a high probability that his brother also has this disease in his anamnesis.

Not long ago, another theory emerged, according to which Horton's syndrome is classified as a collagen pathology. This is a group of diseases in which systemic damage to connective tissue and blood vessels is observed. Specialists draw such conclusions based on the identified uniformity of the pathology in question with periarteritis of a nodular nature. This is comparable at the level of form, structure, color and other parameters.

But whatever the causes of temporal arteritis, the mechanism of its origin and progression is the same: the inflammatory process developing in the patient's body affects the tissues of the mucous walls of the vessels. Due to this, tissue structures are damaged, and a narrowing of the vessel's cross-section is observed, which provokes a deterioration in the nutrition of the organs "served" by these blood vessels. In light of the fact that blood flow in the area of inflammation worsens, this allows a thrombus to form in this place, which is able to completely block the existing lumen.

The consequences of the thrombus formation depend on which blood artery is blocked – for example, it can be ischemic acute cerebrovascular accident or vision loss. Also, the probability of protrusion of the arterial wall (less often – vein) due to its thinning or stretching (arterial aneurysm) increases, which, with high blood pressure, can provoke a rupture of the artery, and, accordingly, the patient will receive acute cerebrovascular accident of a hemorrhagic nature.

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Symptoms of Temporal Arteritis

Depending on the stage and severity of the damage to the human vascular system, the symptoms of temporal arteritis vary somewhat, but there are those that are present at all stages of the development of the pathology.

1. Pain symptoms localized in the temporal region. The intensity of pain varies, it can be dull and monotonous or, more often, sharp and pulsating.
2. Pain symptoms also affect the scalp. Touching usually increases the intensity of pain.
3. Swelling can be observed in the temple area.
4. Such people lose the desire to eat.
5. The pain can also spread to the neck.
6. If Horton's syndrome is accompanied by rheumatoid polymyalgia, then the symptoms of temporal arteritis are joined by pain symptoms in the shoulder and pelvic area.
7. Increased pain intensity in the temple and temporomandibular joint when chewing.
8. During a headache attack, the patient may also experience temporary deterioration of vision. Double vision and a veil may appear in the eyes.
9. Horton's syndrome mostly affects pensioners. At the same time, as statistics show, the weaker half is subject to this disease much more often than the male half of the population.
10. Depending on the individual characteristics of the human body, an increase in body temperature can be observed during an attack.
11. When a headache occurs frequently enough and lasts for a long time, such a person may gradually begin to develop a depressive state.
12. The person feels general malaise.
13. The patient may have problems lifting the eyelid.
14. Advanced temporal arteritis can cause blindness. This is explained by the reduction of blood flow that feeds the optic nerves.
15. Due to the developing aneurysm, an ischemic or hemorrhagic stroke can occur.
16. The skin around the temporal region is slightly hyperemic.
17. Fever.

Giant cell temporal arteritis

Granulomatous vascular disease is necessarily characterized by structural damage to the walls of the temporal arteries. There is a selective damage to smaller branches of the blood column. Very often, giant cell temporal arteritis, being a systemic disorder, is accompanied by another pathology - rheumatic polymyalgia.

In pathological changes, which doctors call giant cell temporal arteritis, immune reactions of the patient's body of humoral and cellular genesis are clearly observed, which affect the elasticity of the vessel walls.

During an acute attack of the disease, blood tests showed a slight increase in the quantitative indicators of immune complexes and serum immunoglobulins. In the active phase of the disease, an increase in the level of circulating lymphoblasts in the patient's plasma can be observed. Although such factors are documented, they do not provide an unambiguous basis for confirming a change in the immune status of a person with a history of giant cell temporal arteritis.

The histological picture of the location of vascular disorders is similar to Takayasu syndrome, but there are also significant differences, especially those related to the age of patients.

Giant cell temporal arteritis is a disease of the elderly. On average, the threshold for the onset of pathological changes is seventy years. In real life, this figure falls within the range of 50 to 90 years. At an earlier age, the appearance of this disease is extremely rare and is more an exception than a rule for this pathology, which always raises doubts about the correctness of the diagnosis.

As clinical observations show, the disease in question is diagnosed in elderly people with good health for their age, which indicates a fairly high immune status. Based on this conclusion, doctors assume that high immunity is necessary to trigger the mechanism of development of this pathology.

Temporal arteritis in children

As mentioned above, the development of Horton's syndrome is quite strongly related to the patient's age. This pathology is a disease of old people. Therefore, temporal arteritis in children is nonsense. But any rule can have rare exceptions.

Diagnosis of temporal arteritis

If pain symptoms occur, it is advisable to consult a neurologist. Diagnosis of temporal arteritis includes:

• Analysis of patient complaints.
• Clarifying the age of the patient.
• The study of blood plasma, in the presence of temporal arteritis, shows a burst of ESR (sedimentation rate of erythrocytes) to units of 50 to 70 mm / h.
• When analyzing blood, a decrease in the number of red blood cells (erythrocytes) is detected, while the physiological characteristics of the color identity are maintained. Leukocytes, in the diagnosis of temporal arteritis, remain, mainly, unchanged.
• The C-reactivity index of the protein is determined. This enzyme is synthesized in the liver. Its appearance in the serum says (as well as a high level of ESR) about the presence of a strong inflammation in the human body.
• As a final feature in the diagnosis of the pathology in question, a temporal artery biopsy is performed. The study is performed using local anesthesia. Take a sample of a small piece of the temporal artery. Samples are carried out using medical equipment, equipped with lenses of multiple magnification. This study allows you to recognize inflammation-affected cells and correct the correct definition of the disease.

The correct recognition of the disease in question is complicated by the fact that physicians do not fully know the causes and specificity of the symptoms of this pathology.

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Treatment of temporal arteritis

Today, treatment of temporal arteritis is carried out using two main methods: surgical intervention and drug methods of relieving the problem.

Therapeutic methods of treating the disease include prescribing glucocorticosteroid hormonal drugs to the patient. In this case, the patient is required to take fairly high doses of these drugs. Very often, when diagnosing this disease, prednisolone is prescribed, as well as its analogues such as decortin, prednisolone hemisuccinate, prednisolone sodium phosphate, medopred, prednisol, decortin solu and others.

Prednisolone belongs to the group of drugs of the adrenal cortex hormones. The quantitative component of this drug is prescribed individually for each patient.

Mostly, the starting daily dosage of the administered drug is determined by a dose of 20-30 mg, which corresponds to four to six tablets. However, based on the pathology picture, the neurologist may prescribe a higher dosage of the administered drug to the patient.

In the acute stage of the disease, prednisolone is usually administered intravenously or intramuscularly in the form of injections. And only after the acuteness of the attack has been relieved can the tablet form of the drug be used again.

The duration of treatment is determined by the attending physician, on average this period is two weeks. Against the background of glucocorticosteroid hormonal therapy, regular monitoring of the patient's blood pressure is recommended. It is necessary to monitor the sugar level and electrolyte balance, as well as conduct a test analysis of feces and urine.

With prolonged use of prednisolone, the treatment protocol includes drugs that can maintain the level of potassium in the patient's blood, and the diet is adjusted. This will prevent the development of hypokalemia (a decrease in the amount of potassium (K) in the body). To reduce the risk of catabolism (differentiation, the process of metabolic breakdown of tissue structures), as well as the progression of osteoporosis (a disease that leads to the leaching of calcium salts from bone tissue), methandrostenolone is prescribed.

Contraindications to the use of the drug in question are individual intolerance of the patient's body to the components of the drug, as well as persistent high blood pressure, diabetes mellitus, acute endocarditis, nephritis, ulcerative lesions of the mucous membrane of the gastrointestinal tract, Itsenko-Cushing's disease, psychoses of various natures, the postoperative period, and an active form of tuberculosis.

Methandrostenolone is administered orally before meals at 5-10 mg, which corresponds to one tablet with an active substance concentration of 0.001 g (1 mg) or 0.005 g (5 mg). The drug is taken once or twice a day. If therapeutically necessary, the daily dosage of the drug can be increased to 30-50 mg.

If this medication has to be taken for a long time, the single dose of the drug is reduced to 5 mg.

Contraindications for the drug in question include prostatitis, malignant neoplasm in the prostate gland, acute liver dysfunction, as well as pregnancy and breastfeeding.

To prevent arterial thrombosis, the patient is prescribed heparin therapy.

Doses and methods of administration of the direct-acting anticoagulant heparin are determined by the attending physician for each patient individually. One of the methods of administration of the drug in question is its intravenous infusion solution in doses of 15,000 - 20,000 U, or the drug is administered intramuscularly at 5,000 - 10,000 U every four hours. The daily dose is 40,000 U. The duration of therapy is five to six days. During heparin therapy, it is imperative to monitor blood clotting indicators. This indicator should be twice as high as normal.

A couple of days before the drug is withdrawn, the dosage taken by the patient is gradually reduced by 5000 - 2500 IU with each subsequent administration, the interval remains the same. After complete withdrawal of heparin, therapy can be continued with indirect anticoagulants.

It is strictly not recommended to prescribe the drug in question in case of individual intolerance to the component composition of the drug, if the patient's medical history includes hemorrhagic diathesis and other pathologies that cause slow blood clotting. Heparin is contraindicated in case of increased vascular permeability, severe disorders in the functioning of the kidneys and liver, anemia, venous gangrene, acute and chronic leukemia, subacute bacterial endocarditis, bleeding of any localization, as well as in case of acute aneurysm.

If there are contraindications to taking heparin, the doctor may prescribe one of its analogues: curantil, clopidogrel, aspirin - angioprotective drugs. To restore blood microcirculation in the affected artery, xanthinol nicotinate or pentoxifylline are introduced into the treatment protocol.

Curantil is prescribed in a dosage of 0.075 to 0.225 g, divided into three to six administrations. After achieving the desired therapeutic effect, the dosage of the drug can be reduced to 0.025 - 0.05 g. The maximum daily amount of the drug should not exceed 0.6 g.

The medicine is taken on an empty stomach or no earlier than an hour after eating.

The drug is contraindicated if the patient's body does not tolerate dipyridamole or other components of curantil, as well as in cases of severe hypotension, terminal stage cardiac or renal dysfunction, acute stage of myocardial infarction, bleeding of unknown etiology, and subaortic stenosis.

In a particularly difficult case of temporal arteritis treatment, the doctor may decide to perform surgery. Angioprosthetics is the removal of affected areas of the venous bed. An indication for this operation may be one of the complications of Horton's syndrome, for example, an aneurysm of the vessels, a violation of the blood supply to the eyeball, an oncological neoplasm affecting the arterial trunk that feeds the temporal region.

The duration of therapy when temporal arteritis is diagnosed is quite long and can range from ten months to a year, or even longer.

Treatment of temporal arteritis with folk remedies

It should be noted right away that pain symptoms affecting the head can be a sign indicating the presence of a serious disease in the human body. Therefore, treatment of temporal arteritis with folk remedies is only an "emergency aid" to alleviate the condition and relieve the severity of the attack. But you should not delay visiting a specialist in such a situation. The earlier the diagnosis is made, the more likely it is that the treatment will solve the problem with the pathology that bothers the patient with the least complications for the body.

First, let's look at herbal decoctions and tinctures that can help relieve or completely eliminate severe headaches.

• Finely chop the peony root and pour vodka over it. The ideal ratio for making an infusion is one part plant to ten parts alcohol. Let the mixture sit for eight to ten days, then strain. Drink one teaspoon three times a day. The greatest effect is achieved by taking the infusion 15 to 20 minutes before the expected meal. At the same time, it is advisable to take flower pollen - half a teaspoon, also three times a day.
• In the diagnosis of temporal arteritis, a decoction of Siberian elder flowers shows high efficiency. Pour one tablespoon of plant material with one glass of just boiled water. Hold for twenty minutes and strain. In case of a headache, take a quarter of a glass with a small amount of honey, practicing three to four doses, administered five minutes before meals.
• The expected result is also given by the herb St. John's wort. A tablespoon of the crushed plant is poured with a glass of boiling water and put on low heat for 15 minutes, after which the decoction is filtered. Take a quarter of a glass three times a day for headaches.
• Peppermint infusion shows good results for headaches. Pour half a tablespoon or one teaspoon with a glass of hot boiled water. Cover the container with the infusion with a lid and wrap it up a little. Keep it on a water bath, stirring constantly, on low heat for 15 minutes. Then put it on the edge of the stove and let it sit for another 45 minutes. After the infusion has cooled, strain it and add boiled water at room temperature to make up to 200 ml. Drink the infusion warm, 30-60 ml one to three times a day, a quarter of an hour before meals. This “medicine” is stored in the refrigerator for no longer than two days without the risk of reducing its medicinal properties.
• Two teaspoons of dried and crushed leaves of the coltsfoot herb are poured with one glass of just boiled water and left to stand under a closed lid for half an hour. This product is drunk after straining four to six times an hour before the expected meal.
• In the diagnosis of temporal arteritis, an infusion of common wormwood leaves shows good results. One teaspoon of crushed plant material is poured with 200 ml of boiling water. Cover the vessel with a lid, in which the medicinal mixture is located, and wrap it up, let the wormwood brew for three to four hours. Drink a third of a glass of infusion, after straining the mixture, three times a day.
• Pour half a liter of boiling water over one tablespoon of crushed oregano. Wrap the vessel containing the infusion well and leave it to infuse for half an hour, after which time strain the mixture. When a headache occurs, take half or a whole glass, making two or three approaches throughout the day. But there is also a warning - this "medicine" should not be taken by women during pregnancy.
• Two teaspoons of dried and crushed flowers of red clover grass are poured with one glass of just boiled water and left to stand under a closed lid for half an hour. Drink this product after straining three times a day.
• The expected result in the treatment of temporal arteritis is also given by the infusion of valerian root. A tablespoon of crushed rhizome is poured with a glass of water at room temperature and left for six to eight hours to infuse, after which the infusion is filtered. Take one tablespoon three times a day for headaches.
• Add one tablespoon of dill seeds to one and a half glasses of boiling water. Let the boiling water steep for half an hour and strain. Take this infusion throughout the day until the pain symptoms subside.

There are also many methods and means of traditional medicine in the treatment of headaches:

• To relieve a pain attack, you can take a large leaf of indoor aloe. Cut it lengthwise into two halves. Apply the plant with the cut to the temporal and frontal parts of the head. Lie down in a dark room for half an hour. The intensity of the pain should decrease, or even disappear completely.
• Another method of treatment also shows good efficiency. In case of painful symptoms, it is enough to apply garlic juice to the forehead and temporal areas with a cotton swab.
• It is worth trying this method of getting rid of headaches. Put ten cloves of garlic in 50 ml of milk and put on low heat. Bring to a boil and hold for five minutes. Let the broth sit for a while and cool to a warm state, then strain. Insert five to ten drops of the "medicine" into the ear canal with a pipette and hold for a minute. Then tilt your head so that the liquid comes out. Do the same with the other ear. This method perfectly relieves pain localized in various areas of the head, including the temples.
• You can try to treat a headache with slices of raw potato, which are placed in gauze and secured to the temple or forehead with a bandage.
• A compress of boiled potatoes in their skins works great in this situation. It is applied warm to the temporal or frontal part of the head. This procedure can help to reduce the inflammatory process occurring in the tissue layers of the systems and organs of the head.
• You can try to just sit down, relax and meditate.
• Raw potato juice, prepared no later than 15 minutes before taking, also relieves pain well. If the pain is constant, drink a quarter of a glass of juice one to three times a day half an hour before meals. The prophylactic and therapeutic course is from seven to ten days.
• If a person is bothered by severe headaches, then you can try to use this advice from traditional medicine: eat potatoes throughout the day. To do this, peel and boil a kilogram of potatoes without using salt. Check the tubers for readiness, drain the liquid. Eat throughout the day, lightly dipping in sugar. You may want to drink, but you should endure until the next morning. The preventive course can be repeated at intervals of a month.
• Sometimes it can be helpful to just rest with your eyes closed or take a little nap.

We can also offer a set of recipes from the famous fortune teller Vanga:

• Take a pillow and fill it with well-dried immortelle grass (also called: Helichrusum arenarium L., sandy cinquefoil, Bogorodskaya grass, gray flowers). After the patient has spent the night on this pillow, take this immortelle grass and, having chopped it well, pour water over it and boil it a little. Set it aside on the side, let it stand for a while and cool down. After washing your hair, rinse it with the resulting decoction.
• The method of using a decoction of peppermint (Mentha peperita L.) is similar. The method of obtaining the decoction is also similar to the previous one.
• If the patient suspects that the pulsation in the temporal part appeared due to a stressful situation, then Vanga recommends putting a tablespoon of granulated sugar in the mouth for several evenings immediately before going to bed. Wash it down with 200 ml of warm boiled water, drinking in small sips.
• In case of chronic headaches, Vanga recommends dousing with thyme decoction (or it is also called savory). There should be at least five liters of water, or even more. Brew the herb in the classic way. Before going to bed, lower your head into the decoction and sit like that for about ten to fifteen minutes. After the time has elapsed, douse and wipe the entire body with the same water.
• For headaches, it is very useful, according to the recommendations of the prophetess, to get up early in the morning and while there is still dew on the grass, walk on it barefoot.
• Drinking chamomile or lemon balm tea shows good results.
• A warm bath is a good way to relieve a headache. Sea salt added to it will help increase its effectiveness, as well as herbal decoctions of valerian root, oat straw and other herbal components with similar properties added to the water.
• The prophetess believes that a mustard plaster placed on the calf muscle area, as well as on the shoulder blade area (but not on the heart area) or on the neck from the back, slightly below the hair, will also help relieve headaches. You should hold for 10-15 minutes and remove the mustard plaster.
• Instead of mustard, similar compresses can be applied using grated horseradish or radish.
• In some cases, the following composition applied to the temporal region may help: boil the beans until fully cooked, mash them well and mix with grated garlic and vegetable oil. It is better to use this "ointment" at night.
• Blackcurrant or viburnum juices are also good for relieving headaches. The juice should be fresh. Drink one to three tablespoons three times a day. This method is effective for severe headaches.
• Sometimes it is enough to just eat some fresh berries and the intensity of the pain decreases. In this case, lingonberries or strawberries will do.
• In case of headache, a decoction of meadow sivets is quite good for relieving an attack. One tablespoon of crushed plant material is poured with one and a half glasses of hot boiled water. Cover the vessel with a lid, in which the medicinal mixture is located, and wrap it up, let it brew for an hour. Drink a third of a glass of infusion, having previously strained the mixture, three times a day.
• Flowers of the elderberry have proven themselves well. Two teaspoons of dried and crushed raw materials are poured with one glass of just boiled water and left to stand under a closed lid for about fifteen minutes. Drink this product after straining three times a day, half a glass at a time. To increase the effectiveness of the infusion, you can add one teaspoon of honey when using it.
• Cinnamon infusion has proven to be excellent in the treatment of temporal arteritis. Pour 20 ml of water at a temperature of 70-80 °C over one gram of crushed product. Add a little sugar, but honey is better (if you are not allergic to bee products). Drink a couple of sips at intervals of an hour. In parallel, this tincture can be applied as compresses to the forehead and to the temples.
• Prepare the mixture: take one portion of savory, two doses of peppermint, two portions of motherwort. Mix the mixture thoroughly. Mix 15 g of the mixture with 200 ml of cold boiled water and put on low heat. From the moment of boiling, let it stand for five to seven minutes, then let it brew for about an hour. Before taking this decoction, add one clove (spice) to it. Drink the liquid warm, one to three tablespoons 30 minutes before meals. This decoction is effective in case of severe pain in the temples.
• For chronic headaches, it is very useful to drink half a glass of buttermilk, yogurt or whey on an empty stomach.
• There is also a proven method for at least partial pain relief: place your forehead against the window glass and stand there for a while, relaxed.
• A freshly picked lilac leaf also works well. It should be applied as a compress to the troubling area. If necessary, a slightly wilted leaf can be replaced with a fresh one, freshly picked.
• Cabbage leaves work in a similar way.
• A headache caused by temporal arteritis will go away if you apply a lemon peel cut two centimeters in diameter and peeled of the white layer to your temples. Apply the wet side to the sore spot and hold until hyperemia appears under the peel and the skin begins to itch.
• Vanga recommends taking an infusion of madder roots. The infusion is easy to prepare at home according to the classic scheme. Drink a third of a glass throughout the day, making one to three approaches.
• Mix a small amount of clay with water until it reaches the consistency of very thick sour cream (it should not spread). Add a few drops of vinegar to the resulting gruel. Apply the resulting "medicine" to the soles of the patient's feet. This procedure helps to provoke a partial outflow of blood from the vessels of the head, which helps to reduce pain, or even completely eliminate it. After applying the ointment, wrap the lower limbs in a napkin and secure them with warm socks on top. It is advisable to keep this compress for about an hour.
• A simpler method of relieving pain is to apply softened clay to the forehead, temples or back of the patient's head.
• You can try rubbing the temple area with the Golden Star balm. Its components not only allow you to relax, but also have sedative properties, which help relieve the throbbing pain in the temples.
• If you don't have a pill at hand and your headache is getting worse, try wiping your temples with a cotton swab soaked in ammonia for one to five seconds. The pain should lose its intensity or even go away completely.

But it should be clarified once again that it is not recommended to treat temporal arteritis with folk remedies. The above-described methods of relieving discomfort are good only for relieving pain symptoms, but do not relieve the patient from the source of the problem. Therefore, a mandatory consultation with a specialist and a full examination are necessary. Only a certified doctor can correctly diagnose and conduct adequate therapy. And it is with him that you should consult about the use of this or that folk medicine recipe to relieve an attack of headache and improve the general condition of the patient.

Prevention of temporal arteritis

Recommendations for primary measures to prevent the development of the disease in question are very problematic, since modern medicine does not have sufficient knowledge about the nature and sources of pathological changes that lead to the disease in question. Secondary prevention of temporal arteritis includes lifelong treatment of the patient with immunosuppressants and steroid hormones. To relieve headache attacks, a person can easily choose the most effective method of traditional medicine for him. But even in this case, a consultation with your doctor will not be superfluous.

Prognosis of temporal arteritis

The distant and near future of a person suffering from Horton's syndrome directly depends on the timeliness of seeking help from a doctor - a neurologist. If the diagnosis was made in time and adequate therapy was carried out, then the prognosis for temporal arteritis can be quite favorable. Following the recommendations of his attending physician, the patient continues to live a full, habitual life.

If the process was neglected at the time of diagnosis, the disease can provoke the development of quite serious complications that do not always respond to medical therapy, do not regress, and lead the patient to disability.

Nature has created our body "wise". And if you often have a headache, you should not self-medicate by taking the first pill that comes to hand. It should be understood that with frequent pain symptoms our body signals about harmful changes that disrupt its normal functioning. If the diagnosis of temporal arteritis is made in time, then the patient's body will be subject to the least destruction, and the subsequent life of the patient, if the specialist's recommendations are followed, will not differ much from the life of a healthy person. If a person ignores the pain symptoms, he may soon face the fate of a disabled person. Therefore, you should pay close attention to your health and seek advice from a qualified specialist in a timely manner.