What is the focus of physical exam in patients with suspected giant cell arteritis (GCA) (temporal arteritis)?

Updated: Sep 03, 2020
  • Author: Mythili Seetharaman, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Physical signs parallel symptoms and depend on the organ systems that are damaged by vasculitic ischemia. The clinician should conduct a head and neck, ophthalmologic, and neurologic examination and assess vital signs and blood pressure in both arms to rule out aortic arch involvement.

Approximately half of patients have signs of superficial temporal artery inflammation, including erythema, pain on palpation, nodularity, thickening, or reduced pulsation on the affected side (see the image below). The examiner may be able to roll an affected temporal artery between the fingers and the skull.

Prominent temporal artery is visible on the temple Prominent temporal artery is visible on the temple of a 76-year-old woman with temporal arteritis. Courtesy of ScienceSource (https://www.sciencesource.com/).

Gentle pressure on the scalp may elicit focal or generalized tenderness. This differs from the hypersensitivity or hyperesthesia (unusual discomfort from a very mild stimulus, such as gently stroking the patient's hair) that is commonly found with migraine. [66]

Tenderness to pressure on the carotid artery (carotodynia) occurs in about 15% of patients. Cranial nerve palsies, particularly of the sixth nerve, should also be noted. The carotid, axillary, and brachial arteries should be assessed for bruits. Carotid bruits occur in 10-20% of patients with giant cell arteritis (GCA) and are frequently bilateral.


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