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Brain - Inflamation of Arteries

 
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PostPosted: Dec Sat 16, 2006 8:18 pm    Post subject: Brain - Inflamation of Arteries Reply with quote

Brain - Inflamation of Arteries

Has anyone had any experience with treating or ever heard of inflamation of arteries in the brain? The Dr.'s are calling it Giant Cell Arterial or Temporal Arterial? Symptoms are severe headache and nausea. PLEASE send me a message right away if you know anything about this or what to do about it. Thank you. -Charlotte
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Disease basics
This arteritis (inflammation of arteries) occurs in elderly people with a peak incidence from ages 60-75. It's rare below the age of 50. It's called "giant cell" because multinucleated large cells are often seen as part of the cellular infiltrate in the arterial walls, and it's also called "temporal" because the scalp arteries in the temples are often prominently inflamed. It affects white people almost exclusively, but has been reported in black Americans. The female/male ratio is about 3/1. The annual incidence of the disease in people older than 50 in northern Europe, where the disease is most common, is 18/100,000.

The arteritis is limited to arteries with elastic tissue. Besides the temporal artery, other arterial branches of the external carotid artery are commonly involved, such as those to the face and tongue. Also commonly involved are the ophthalmic artery and its ciliarly and central retinal artery branches, occlusion of which causes the most dreaded complication of the arteritis--sudden painless blindness in one eye. Involvement of the vertebral or carotid arteries occurs, but transient ischemic attacks or cerebral infractions are uncommon.

The clinical syndrome known as polymyalgia rheumatica affects the same populations as does giant-cell arteritis and shares many of its clinical and pathological features. It's considered to be another manifestation of the disease process underlying giant-cell arteritis. A minority, but a considerable percentage, of patients with polymyalgia rheumatica have giant-cell arteritis and roughly half of those with giant-cell arteritis have symptoms of polymyalgia rheumatica.

Symptoms of giant-cell arteritis
The symptoms vary considerably among patients. They are usefully classified as arteritic, systemic, and myalgic.

Arteritic
Headache is present in the great majority of patients, though it's not always the predominant complaint. It's often felt in both temples, but only one may be involved or the headache may have other distributions, such as frontal, diffuse, or occipital. The headache is as often continuous as it is intermittent. Its intensity varies from mild to marked among patients. The pain often is felt as superficial. Many patients have soreness of their scalps--pressing on their heads, brushing their hair, or laying their heads on a pillow is painful.

Pain in the jaw or temple while chewing is common. It's caused by impaired blood supply of the muscles of mastication.

Sudden painless deterioration of vision of one eye from ischemia of the optic nerve may be transient or permanent. The other eye may be affected later.

Transient ischemic attacks or cerebral infarctions, most often in the territory of the vertebral artery, are uncommon.

Systemic
These are the non-specific symptoms of inflammatory or infectious diseases or malignancies and consist of malaise, anorexia, weight loss, fever, night sweats, and depressed mood.

Myalgic
These symptoms are those of polymyalgia rheumatica, which are present in about half of patients with giant-cell arteritis. They are pain and stiffness in the neck and proximal muscles of the upper and lower limbs. The stiffness and pain are worsened by rest, so much so as to make getting out of bed in the morning extremely difficult. Muscle weakness is absent.

Examination findings in giant-cell arteritis
The main finding, present in a majority of the patients, is swollen, nodular, tender temporal arteries often with diminished pulsations. When visual loss has occurred, the optic disk is pale and swollen.

Laboratory findings
The most useful test to help confirm or exclude the clinical diagnosis is the erythrocyte sedimentation rate (ESR). Normal values for the Westegren method are less than 20 mm/hr for healthy adults under 60 years of age, but perhaps as high as 40 mm/hr in older persons. In giant-cell arteritis, the ESR is probably greater than 50 mm/hr in 90% of patients and within the normal range or borderline normal in about 1-2 %. It should be done in all patients suspected to have giant-cell arteritis, not only for its confirmatory value, but to establish a baseline level by which to judge the effects of therapy. An elevated ESR does not, however, establish the diagnosis of giant-cell arteritis, since elevations are not specific for this disease.

A temporal-artery biopsy can establish the diagnosis by showing the characteristic histology of the disease. In brief, this is the presence of an inflammatory cellular infiltrate with giant cells in an artery with a disrupted media and internal elastic lamina and a thickened, edematous intima. Roughly a third of patients with symptoms and signs of temporal arteritis have false-negative biopsies. The advisability of requesting a biopsy will vary with the particular characteristics of the patient's illness and the physician's assessment of the influence of a positive or negative biopsy on his treatment plan. For example, in an elderly patient with classic headache, systemic symptoms, swollen tender temporal arteries, and an markedly elevated ESR, a biopsy seems superfluous. On the other hand, in an elderly patient with only slightly suggestive symptoms/signs and a mildly elevated ESR, the physician would probably not want to initiate corticosteroid therapy without biopsy confirmation of the disease. If the symptoms/signs strongly favor the disease, but lack certitude, therapy should not be delayed while waiting for the biopsy, lest visual loss occur during this interval.

Differential diagnosis of the headache
When the headache is continuous or nearly so and when it's accompanied by unimpressive systemic symptoms and no polymyalgic symptoms, then chronic tension-type headache is the most likely alternative diagnosis. Less likely, but a consideration, is headache from brain tumor.

Treatment
Corticosteroids are essential therapy for giant-cell arteritis (and polymyalgia rheumatica). This therapy not only alleviates the symptoms of the disease dramatically (symptom relief in 48-72 hours), but offers great protection against the occurrence of visual loss. The initial dose should be 20-40 mg (opinions vary) of prednisolone or prednisone daily, perhaps 80 mg when visual disturbances have appeared. Once the symptoms have been suppressed, the dose can be gradually reduced, by, say, 5 mg weekly as long as symptoms remain suppressed and the ESR shows no clear rise. When a dose of 10 mg has been reached, then slower reductions by 1 mg every few weeks is preferable until symptoms begin to reappear or the ESR rises. Then the last dose which suppressed the symptoms and the ESR should be maintained for a few years. If the maintenance dose is so large as to produce the adverse effects of long-term corticosteroid therapy, then azathioprine may be added to lower the maintenance dose of the corticosteroid. -Dee
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I wonder if this is some kind of autoimmune type disease where the body actually attacks itself. It doesn't really say.

It seems like support should be given to strengthen the immune system. I would also want a nutrient like Nutri-Calm, Noni, enzyme therapy, anti inflammatory. However, this appears to be an acute illness which requires immediate therapy with steroids to reduce inflammation, because of risk of vision loss due the swelling on the nerves around the eye.

I think another I'd do for myself is try to use products that would strengthen the integrity of the elasticity of my vessels to keep the blood moving. Maybe Red Raspberry, Grapine, Bilberry, and Capsicum, Butchers Broom might help. -Dee
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Add 12-16 Rose Hips daily also to reduce inflammation and repair the arteries. -Miss Sunshine

Hi my name is Maria. And I am writing with regards to your request for more information on the condition known as temporal arteritis. My mother actually suffered with this condition some time ago. Just woke up one morning and had completely lost her sight. As in could only see dark shadows. Luckily it was caught as in diagnosed in time and was successfully treated. Following a fairly long course of steroids her sight returned and is now almost completely normal again. However if it had not been diagnosed as in caught in time the scenario would have been a lot different as in permanent blindness. Which is what she was told. Apparently it is caused by inflamation of the arteries at the back of the eye. Which if left too long can and does cause permanent damage. I suffer quite a lot with really bad headaches jaw problems and such also. And I believe this is because of inflamation of the arteries in and around the brain. Which is sometimes just referred to as cluster headaches or as in connected with it. Which can be extremely painful and very debilitating if nothing is done about it. As in anti inflammatory drugs etc. They do say this condition is not necessarily hereditary but I guess it also can be. Best always -Maria.
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