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oPresence of indurated cord-like temporal artery that is warm and tender. oJaw claudication (pain with chewing that is relieved when the pt stops chewing. oVisual symptoms: Amaurosis fugax (transient monocular loss of vision) or partial visual field defect and/or blindness. oLow grade feveroFatigueLabsoESR/ sedimentation rate : often reaches 100 mm/hr or moreNormal Range: MEN: 0-22mm/hr WOMAN: 0-29 mm/hr oCRP: will be elevatedTreatmentoRefer to ophthalmologist or ED statoTemporal artery biopsy is gold standard and is done by ophthalmologist of surgeon. oHigh 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: oBilateral joint stiffness and aching (lasting 30 minutes or longer) commonly in theAM). Located in the shoulders, neck, hips, and/or torso. oCommonly causing issues with putting on clothes, /bra, having difficulty getting up from bed and/ or chair. Risk FactorsoFemales 50 y/o or greater Treatment:
oSymptoms usually respond well to PO steroids. Trigeminal NeuralgiaTrigeminal 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: ounilateral facial pain that follows one of the branches of the trigeminal nerve. oPain close to the nasal border and checks. Different TypesoType 1: extreme shock-like facial pain lasting from second to 2 minutes per episode) oType 2: constant, aching, burning facial pain of low intensitiy, More common in Woman and peaks in their 60’s. Treatment: oAnticonvulsants: Carbamazepine (Tegretol) or Phenytoin (Dilantin) oMuscle Relaxants are effective when combined with Anticonvulsants Oxcarbazepine (Trileptal) used at 1stline defense drug b/c less S/E’s. Gabapentin and topiramate are also used. oCT/ 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: oone side of face paralyzed, odifficulty chewing or swallowing on the same side.oUnable to fully close eyelid. Treatment Plan: oR/ O stroke, TIA, mastoid infections, bone fx, Lyme disease and/ or tumoroCorticoidsteroids at high doses X 10 days then weaning offoAcyclovir if herpes simplex suspected. oProtect cornea from drying and ulceration with eye lubricants in AM and lubricating ointments at HS.