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Klin Monbl Augenheilkd 2003; 220(9): 579-617
DOI: 10.1055/s-2003-42809
DOI: 10.1055/s-2003-42809
Übersicht
© Georg Thieme Verlag Stuttgart · New YorkArteriitis cranialis - Ein Überblick
(Arteriitis temporalis Horton, Riesenzellarteriitis)Cranial arteritis - An Overview(Temporal Arteritis, Giant Cell Arteritis, also known as Horton's Arteritis)Further Information
Publication History
Eingegangen: 21. Juli 2003
Angenommen: 25. August 2003
Publication Date:
08 October 2003 (online)
Zusammenfassung
Hintergrund: Das Krankheitsbild der Arteriitis cranialis stellt eine der wichtigsten ophthalmologischen Notfallsituationen dar. Methodik: Literaturübersicht unterschiedlicher diagnostischer Möglichkeiten und therapeutischer Empfehlungen. Ergebnisse: Die grundlegenden diagnostischen Schritte, insbesondere die „5-Kriterien-Klassifikation” (einschließlich bestimmter Ausnahmen) sowie die Erkennung unterschiedlicher Facetten des Krankheitsbildes, werden herausgestellt. Sonderformen der Krankheit, vor allem die Entzündung der A. facialis, A. occipitalis und der A. vertebralis, werden unterschieden. Eine Arteriitis ohne Kopfschmerzen (okkulte Arteriitis) wird meistens zu spät erkannt. Bei fehlenden klassischen Symptomen besteht die große Gefahr einer Fehldiagnose. Die anteriore ischämische Optikusneuropathie (AION) stellt die häufigste Erblindungsursache dar. In der Differenzialdiagnose zur nichtarteriitischen AION werden die charakteristischen Befunde der arteriitischen AION herausgestellt. Die unterschiedlichen Auffassungen zur ein- oder beidseitigen Arterienresektion („Biopsie”) sowie die Befunde der Farb-Duplex-Sonographie der Schläfenarterie im Vergleich zum histologischen Ergebnis werden hervorgehoben. Zusätzliche neuere diagnostische Verfahren wie die MRI-Untersuchung mit Gadolinium und PET-Scan-Untersuchungen können diagnostisch hilfreich sein. Schlussfolgerungen: Erkrankungen an Arteriitis cranialis wurden in den letzten Jahren häufiger diagnostiziert. Die Diagnose sollte von Augenärzten gemeinsam mit Internisten und Neurologen gestellt werden. Erblindungen traten dann auf, wenn die Krankheit zu spät erkannt wurde. Die jahrzehntelange klinische Erfahrung hat dazu geführt, eine hochdosierte systemische Therapie stets frühzeitig zu veranlassen, um Blindheit zu verhindern.
Abstract
Background: Cranial arteritis is one of the most important emergency situations in ophthalmology. Method: Recommendations of the literature how to diagnose and how to treat the disease are described. Results: The basic diagnostic steps such as the „Five Criteria Classification” together with certain exceptions of the classification criteria and the recognition of different facets of the varying clinical picture are emphasised. Special arteritic appearances of the facial artery, the occipital artery and the vertebral artery should be noted and identified. It is pointed out that an arteritis without headache is of great clinical importance, known as occult arteritis, because of the lack of classical symptoms, often leading to a wrong diagnosis. Anterior ischaemic optic neuropathy (AION) is the most frequent cause of blindness. Differential diagnosis between non-arteritic and arteritic AION is emphasised. The different arguments concerning the performance of unilateral or bilateral arterial resection („biopsy”) and the findings of colour duplex ultrasonography in comparison to the histological results are discussed. It is also pointed out that some new diagnostic procedures such as the MRI examination with gadolinium and the PET-Scan examination may be helpful in supporting the diagnosis. Conclusions: Cranial arteritis is more often diagnosed in recent years. The diagnosis should be made in cooperation by the ophthalmologist and internists and neurologists. Blindness caused by cranial arteritis is preventable in the majority of patients if diagnosed early and treated properly. For decades of clinical experience it has been well established that early diagnosis and systemic treatment with high doses of systemic corticosteroids are essential in preventing blindness in one or both eyes.
Schlüsselwörter
Riesenzellarteriitis - anteriore ischämische Optikusneuropathie - Zentralarterienverschluss - Duplex-Sonographie - Kopfschmerzen - histologischer Arterienbefund
Key words
Giant cell arteritis - anterior ischaemic optic neuropathy - central retinal artery occlusion - Duplex sonography - headache - histological arterial findings
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Prof. Dr. Dieter Schmidt
Universitäts-Augenklinik
Killianstraße 5
79106 Freiburg
Phone: 0761/270-4001
Fax: 0761/270-4075
Email: schmidtd@aug.ukl.uni-freiburg.de