Temporal arteritis is an inflammatory condition that affects the walls of medium-sized and large arteries.  On light microscopic exam, granulomas are seen in the media of the arteries, consisting of mononuclear infiltrates and multinucleated giant cells.  Due to the characteristic histologic features, this condition is also called giant cell vasculitis.  The changes in the arteries are segmental: abnormal areas are interspersed by segments of normal-appearing arterial wall. Affected segments cause narrowing of the vessel with a decrease in blood supply to the perfused areas.

The median age of onset of the temporal arteritis is 65 years.  Commonly reported symptoms include:

1. Headache: Focal pain over the temple and tenderness on palpation may be present.  Sometimes patients have scalp tenderness with hair combing. Superficial temporal artery inflammation may cause pain, nodularity, and thickening found on palpation of the temporal area.
2. Craniofacial pain syndromes: Jaw claudication, tongue claudication, and facial pain may occur.  This tends to appear during mastication (chewing) when the blood supply to the corresponding areas does not increase normally due to the narrowing of the arterial lumens.
3. Polymyalgia rheumatica occurs in more than half of patients with temporal arteritis.  It is characterized by neck, torso, shoulder, and pelvic girdle pain and morning stiffness.  Fatigue, fever, and weight loss may also occur.
4. Sudden vision loss is a dreaded complication of temporal arteritis.  It may be transient or may result in permanent blindness.

Educational Objective:
Polymyalgia rheumatica occurs in more than half of patients with temporal arteritis.  It is characterized by neck, torso, shoulder, and pelvic girdle pain and morning stiffness.  Fatigue, fever and weight loss may also occur.  Monocular vision loss is a common complication of temporal arteritis.