BOF: 27
A 60-year-old female presents with a severe left-sided
temporal headache. The temporal artery is tender, pulsation is lost and the
overlying skin is erythematous. The E.S.R. is 80 mm in the first hour.
In this patient
a)
A short course of high dose steroid should be prescribed
b)
The E.S.R. is not a reliable guide to use when reducing the dosage of
steroids
c)
The headache subsides within hours of commencing the patient on high
dose steroid
d)
Lifelong steroid treatment will be required
e)
As steroids may be harmful in elderly patients, treatment should be
delayed until the results of temporal artery biopsy are available
Answer:
c)
The patient has temporal arteritis. The diagnosis is
confirmed by biopsy but in view of the serious complications that may occur
treatment with high-dose steroids should be started immediately. Reduction of
steroid dosage is guided by the fall in the E.S.R. but the duration of
treatment would be several months to years.
