A 70 year old patient comes with complaint of headache, nausea, tenderness over temporal region, diagnosis is:

 # A 70 year old patient comes with complaint of headache, nausea, tenderness over temporal region, diagnosis is? 

A. Aneurysmal arterial dilatation with sub-intimal inflammation 

B. Granulomatous inflammation with giant cell arteritis

C. Luminol thrombosis 

D. Acute organizing thrombus formation

The correct answer is B. Granulomatous inflammation with giant cell arteritis.

Temporal arteritis is to be suspected in an elderly patient presenting with headache, visual symptoms (blindness), fever, malaise, weakness, pain and tenderness over temporal artery (thick cord like sensation) and a raised ESR. 

Temporal (giant cell) arteritis is an inflammatory disorder of arteries that frequently involves the extracranial carotid circulation. The average age of onset is 70 years (elderly), and women account for 65% of cases. About half of patients with untreated temporal arteritis develop blindness due to involvement of the ophthalmic artery and its branches. lschemic optic neuropathy induced by giant cell arteritis (granulomatous inflammation) is the major cause of rapidly developing bilateral blindness in patients >60 years. 

Typical presenting symptoms include headache, polymyalgia rheumatica jaw claudication, fever, and weight loss. Headache is the dominant symptom and often appears in association with malaise and muscle aches. Head pain may be unilateral or bilateral and is located temporally in 50% of patients but may involve any and all aspects of the cranium. Pain usually appears gradually over a few hours before peak intensity is reached; occasionally, it is explosive in onset. 

The erythrocyte sedimentation rate (ESR) is often, though not always, elevated; a normal ESR does not exclude giant cell arteritis. A temporal artery biopsy followed by immediate treatment with prednisone (glucocorticoids) 80 mg daily for the first 4-6 weeks should be initiated when clinical suspicion is high.