o Presence of indurated cord like temporal artery that is warm and tender o Jaw

O presence of indurated cord like temporal artery

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o Presence of indurated cord-like temporal artery that is warm and tender. o Jaw claudication (pain with chewing that is relieved when the pt stops chewing. o Visual symptoms: Amaurosis fugax (transient monocular loss of vision) or partial visual field defect and/or blindness. o Low grade fever o Fatigue Labs o ESR/ sedimentation rate : often reaches 100 mm/hr or more Normal Range: MEN: 0-22mm/hr WOMAN: 0-29 mm/hr o CRP: will be elevated Treatment o Refer to ophthalmologist or ED stat o Temporal artery biopsy is gold standard and is done by ophthalmologist of surgeon. o High dose prednisone for several weeks, and referral to rheumatology specialist for management. Polymyalgia Rheumatic (PMR) VERY high risk for developing Temporal Arteritis, so educate pt’s on how to recognize the symptoms of temporal arteritis. Clinical Manifestations: o Bilateral joint stiffness and aching (lasting 30 minutes or longer) commonly in the AM). Located in the shoulders, neck, hips, and/or torso. o Commonly causing issues with putting on clothes, /bra, having difficulty getting up from bed and/ or chair. Risk Factors o Females 50 y/o or greater Treatment:
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o Symptoms usually respond well to PO steroids. Trigeminal Neuralgia Trigeminal nerve has 3 divisions (ophthalmic, V1, Maxillary (V2), and Mandiublar (V3) and is caused by compression of the nerve root by an artery or tumor. Clinical Manifestations: o unilateral facial pain that follows one of the branches of the trigeminal nerve. o Pain close to the nasal border and checks. Different Types o Type 1: extreme shock-like facial pain lasting from second to 2 minutes per episode) o Type 2: constant, aching, burning facial pain of low intensitiy, More common in Woman and peaks in their 60’s. Treatment: o Anticonvulsants: Carbamazepine (Tegretol) or Phenytoin (Dilantin) o Muscle Relaxants are effective when combined with Anticonvulsants Oxcarbazepine (Trileptal) used at 1 st line defense drug b/c less S/E’s. Gabapentin and topiramate are also used. o CT/ MRI: scan to r/o tumor or artery pressing on nerve or Multiple sclerosis. Bell’s Palsy Abrupt onset of unilateral facial paralysis due to dysfunction of the motor branch of the facial nerve (CNVII). Facial paralysis can progress rapidly in 24hours. Etiology: viral infection, autoimmune process, or pressure form tumor or blood vessel. CM: o one side of face paralyzed, o difficulty chewing or swallowing on the same side. o Unable to fully close eyelid. Treatment Plan: o R/ O stroke, TIA, mastoid infections, bone fx, Lyme disease and/ or tumor o Corticoidsteroids at high doses X 10 days then weaning off o Acyclovir if herpes simplex suspected. o Protect cornea from drying and ulceration with eye lubricants in AM and lubricating ointments at HS.
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