Prevention of serious ophthalmic and cerebral complications in temporal arteritis?

Five patients (mean age 81.6 years) developed bilateral blindness and 3 additional patients suffered cerebral strokes (mean age 58 years) due to temporal arteritis. Bilateral blindness and strokes occurred despite corticosteroid treatment.

In all patients with temporal arteritis, the diagnosis was made too late. Patients with bilateral blindness were referred to the Eye Hospital when one eye had already become blind. The delay between the first symptoms and blindness in one eye was (average) 7 weeks. The interval between blindness of the first and second eyes was (average) 5 days in 3 patients, and simultaneous blindness in both eyes occurred in 2 patients. The other eye also became blind despite mega-doses of prednisone in 3 patients. Three additional patients already showed neurological signs and symptoms at the beginning of the temporal headache. All 3 patients developed strokes after some weeks or months. The wrong diagnosis was made in the first examination(s) by the physician with patients having prodromal signs or symptoms, but who also showed signs of other vascular diseases (diabetes mellitus, hypertension or occlusion of the internal carotid artery) which masked the inflammatory disease of temporal arteritis.

Early diagnosis is essential to prevent severe complications. In patients with a cerebral stroke the early neurological deficits are warning signs which means that one must observe the patient regularly at short intervals. After the diagnosis has been settled, treatment of the patients for several months with a high dosage of corticosteroids is mandatory.