A fictional 74-year-old develops a new temporal headache, jaw claudication and transient monocular visual loss with scalp tenderness.
Frame the danger first.
- New headache, jaw or tongue claudication and visual symptoms in an older adult should raise immediate concern for giant cell arteritis.
- Normal inflammatory markers reduce probability but do not safely exclude the diagnosis when clinical suspicion is strong.
- Examine vision, pupils, cranial nerves and temporal arteries and ask about polymyalgia symptoms.
Act, escalate, reassess.
- Seek same-day ophthalmology and rheumatology/senior assessment for visual symptoms.
- Follow the current local/BSR pathway for immediate glucocorticoid treatment without waiting for confirmatory testing when suspicion is strong.
- Obtain baseline investigations promptly and coordinate confirmatory vascular imaging or biopsy without delaying treatment.
- Assess the fellow eye, vascular complications and treatment risks and document safety-netting.
Red flags that change pace.
- Transient or persistent visual loss, diplopia or objective visual deficit
- Stroke symptoms, tongue ischaemia or aortic/large-vessel symptoms
- Rapid progression, diagnostic uncertainty or major treatment contraindication
What makes care less safe.
- Waiting for biopsy or imaging before treating threatened vision
- Excluding disease solely because inflammatory markers are normal
- Failing to arrange urgent specialist follow-up and treatment-toxicity prevention
Say the concern plainly.
Suspected giant cell arteritis with cranial symptoms [summary], visual findings [details] and inflammatory markers [results/pending]. Symptoms began at [time]; emergency treatment and same-day ophthalmology/rheumatology assessment are [status].