Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with new-onset localized temporal headache, scalp tenderness, and jaw claudication. Associated symptoms include constitutional malaise, low-grade fever, unintentional weight loss, and fatigue. Patient denies visual disturbances, diplopia, or transient monocular blindness (amaurosis fugax). No history of polymyalgia rheumatica symptoms.
Clinical Examination Findings
HEENT: Temporal arteries are prominent, indurated, and tender to palpation with diminished or absent pulses bilaterally. No scalp necrosis or skin ulceration. Ocular: Pupils equal, round, and reactive to light; no afferent pupillary defect. Funduscopic exam reveals no disc edema or pallor. Neurological: Cranial nerves II-XII intact; no focal motor or sensory deficits.
Treatment Protocol
Initiate high-dose systemic corticosteroids (Prednisone 1mg/kg/day) immediately to prevent irreversible vision loss. Order STAT ESR and CRP levels. Arrange for temporal artery biopsy within 72 hours. Initiate bone protection (calcium/vitamin D) and consider proton pump inhibitor for gastric prophylaxis. Monitor for steroid-related side effects.