[
  {
    "start": 0.38,
    "end": 7.58,
    "text": "Welcome to EA Uncast, your weekly source for education research and updates from the European Academy of neurology."
  },
  {
    "start": 22.159,
    "end": 41.64,
    "text": "and I had the neurocritical care unit in Germany, Hamburg."
  },
  {
    "start": 42.46,
    "end": 48.54,
    "text": "Today i am absolutely delighted to introduce a friend, a long-time colleague Arianna Lovrenci-Eschuzian."
  },
  {
    "start": 48.76,
    "end": 55.22,
    "text": "she's full professor of Neurology at University of Zagreb And our new expert in Neurosonology."
  },
  {
    "start": 55.28,
    "end": 56.04,
    "text": "Good morning!"
  },
  {
    "start": 56.379,
    "end": 59.5,
    "text": "Arianna is wonderful To have you here."
  },
  {
    "start": 59.98,
    "end": 60.519,
    "text": "How are you?"
  },
  {
    "start": 61.48,
    "end": 62.54,
    "text": "Fine Thank You."
  },
  {
    "start": 63.8,
    "end": 68.34,
    "text": "So, we know that our podcast will talk about temporal arthritis."
  },
  {
    "start": 68.6,
    "end": 73.58,
    "text": "But coming to this syndrome what describes its condition?"
  },
  {
    "start": 74.94,
    "end": 89.88,
    "text": "Actually the temporal arthritis is more accurately called giant cell arthritis This chronic inflammatory disease of medium and large size arteries."
  },
  {
    "start": 90.5,
    "end": 108.7,
    "text": "It most prominently affects branches of the external parotid artery, such as temporal artery and it typically occurs almost exclusively in individuals older than fifty years."
  },
  {
    "start": 108.899,
    "end": 118.0,
    "text": "And is clinically important because can lead to irreversible visual loss if not recognized."
  },
  {
    "start": 121.0,
    "end": 130.96,
    "text": "Thank you for your introduction, but the next question is why it's called joint arteritis and not temporal arteritis?"
  },
  {
    "start": 132.56,
    "end": 149.52,
    "text": "The condition is called joint cell arteritis because the name describes the underlying pathology whereas temporal arteritis describes only one common location where the disease occurs."
  },
  {
    "start": 150.34,
    "end": 159.72,
    "text": "From pathologic point of view, under the microscope affected are studies show information about the basal wall."
  },
  {
    "start": 159.88,
    "end": 167.2,
    "text": "that means arthritis and large multi-muclic immune cells called giant cells."
  },
  {
    "start": 167.76,
    "end": 174.94,
    "text": "These giant cells are formed when macrophages fuse as part of the immune response."
  },
  {
    "start": 175.48,
    "end": 183.24,
    "text": "their presence is characteristic of disease although they are not seen in every pharmacy."
  },
  {
    "start": 183.92,
    "end": 197.28,
    "text": "The disease often involves the temporal artery, but certain patients don't have the affection of the temporal arteries or other"
  },
  {
    "start": 197.96,
    "end": 198.62,
    "text": "questions.\"."
  },
  {
    "start": 200.14,
    "end": 203.74,
    "text": "Okay thanks for this explanation."
  },
  {
    "start": 204.24,
    "end": 209.4,
    "text": "and if you're seeing a patient with which kind of symptoms?"
  },
  {
    "start": 210.24,
    "end": 213.66,
    "text": "Usually, there is a new onset headache."
  },
  {
    "start": 214.22,
    "end": 219.78,
    "text": "It's often over the temples but may be diffused."
  },
  {
    "start": 220.38,
    "end": 231.76,
    "text": "then there are skull tendons, jaw pain while chewing this is called jaw claudication and visual problems."
  },
  {
    "start": 234.02,
    "end": 238.86,
    "text": "But do you know how many vessels could be affected by this condition?"
  },
  {
    "start": 240.44,
    "end": 249.68,
    "text": "A lot of arteries can be affected, mostly at the temporal artery and its branches."
  },
  {
    "start": 249.98,
    "end": 262.979,
    "text": "However it also affects common carotid artery, sublavian axilla artery but also large vests like aorta."
  },
  {
    "start": 265.099,
    "end": 274.76,
    "text": "Okay, and of course we have some typical symptoms that can induce ourselves to think is a temporal arthritis."
  },
  {
    "start": 275.64,
    "end": 283.9,
    "text": "After this clinical-typical condition you know what he has to do in the first instance?"
  },
  {
    "start": 284.34,
    "end": 287.44,
    "text": "Do you measure some lab or parameters?"
  },
  {
    "start": 294.06,
    "end": 313.68,
    "text": "Yes, of course these patients will have information so you should perform the laboratory parameters that show increase inflammatory markers like CRP or sedimentation rate."
  },
  {
    "start": 314.32,
    "end": 320.3,
    "text": "They may have non-macetic anemia and reactive thrombocytosis."
  },
  {
    "start": 321.479,
    "end": 335.28,
    "text": "There is also huge overlap with polymyalgorithmatica, therefore this patient may present pain and morning stiffness in the shoulder."
  },
  {
    "start": 338.3,
    "end": 339.46,
    "text": "Oh thank you."
  },
  {
    "start": 339.859,
    "end": 342.74,
    "text": "I understand we have to think about it."
  },
  {
    "start": 343.12,
    "end": 348.099,
    "text": "so but uh... We are speaking talking about ultrasound."
  },
  {
    "start": 348.76,
    "end": 354.62,
    "text": "So I would be interested to know which is the head value of ultrasound in this condition?"
  },
  {
    "start": 356.539,
    "end": 368.74,
    "text": "Yes, point-of-care or heart resolution duplex onography of temporal artery typically reveals some characteristic finding."
  },
  {
    "start": 369.28,
    "end": 371.039,
    "text": "This is a halo sign."
  },
  {
    "start": 371.78,
    "end": 382.159,
    "text": "that means vessel wall edema and If you press with the Pro, then the color flow will collapse."
  },
  {
    "start": 382.359,
    "end": 387.34,
    "text": "However this halo sign would still be present."
  },
  {
    "start": 388.0,
    "end": 398.919,
    "text": "This is called non-compressible halo sign and also some stenosis or occlusion may be visible."
  },
  {
    "start": 399.8,
    "end": 405.62,
    "text": "So these are important findings in ultrasound images."
  },
  {
    "start": 406.3,
    "end": 414.0,
    "text": "Usually we perform the ultrasound at the end of clinical examination."
  },
  {
    "start": 415.599,
    "end": 425.96,
    "text": "Okay, quite interesting and do you realize other possibility diagnostic possibilities to make the diagnosis possible or probable?"
  },
  {
    "start": 427.099,
    "end": 427.32,
    "text": "Yes!"
  },
  {
    "start": 427.419,
    "end": 438.979,
    "text": "Of course historically because the disease was known arteries and they are easy to digest."
  },
  {
    "start": 439.62,
    "end": 442.82,
    "text": "Temporal artery valves, it was performed."
  },
  {
    "start": 443.28,
    "end": 454.419,
    "text": "but if you suspect large vessels then MR imaging city and geography of that are indicated in such cells."
  },
  {
    "start": 455.78,
    "end": 457.4,
    "text": "Thank You Pat."
  },
  {
    "start": 457.62,
    "end": 460.38,
    "text": "we're talking about a protocol for ultrasound."
  },
  {
    "start": 460.58,
    "end": 462.039,
    "text": "do have any recommendation?"
  },
  {
    "start": 462.8,
    "end": 466.58,
    "text": "How long do you take the examination?"
  },
  {
    "start": 467.76,
    "end": 472.12,
    "text": "The examination will take fifteen to twenty minutes."
  },
  {
    "start": 472.919,
    "end": 504.419,
    "text": "It is important always to assess both sides, that means each artery biologically – the temporal artery with its common tract and frontal and parietal branch, axilla... occipital artery, vertebral artery than also common carotid artery as well as internal and external carotida artery."
  },
  {
    "start": 505.18,
    "end": 519.32,
    "text": "But if the patient have pain for example at a face then also facial arteries should be examined in Suclavian or Brachial artery."
  },
  {
    "start": 521.0,
    "end": 525.08,
    "text": "Quite interesting, good overview of all a lot of arteries."
  },
  {
    "start": 525.94,
    "end": 534.34,
    "text": "And could you repeat another time the typical characteristic key findings for this condition in ultrasound please?"
  },
  {
    "start": 536.36,
    "end": 548.32,
    "text": "First this is a halo sign then a non compressible halo sign and then the notice or explosion of an artery."
  },
  {
    "start": 550.54,
    "end": 555.28,
    "text": "Thanks And of course, the next question is a curious question."
  },
  {
    "start": 555.5,
    "end": 559.88,
    "text": "Why we... or you choose ultrasound and not biopsies?"
  },
  {
    "start": 559.92,
    "end": 564.58,
    "text": "Is that ultrasound more sensitive to biopsy yes or no?"
  },
  {
    "start": 565.84,
    "end": 571.4,
    "text": "What kind of experience do you should have for performing an ultrasound?"
  },
  {
    "start": 573.08,
    "end": 574.48,
    "text": "A lot of questions!"
  },
  {
    "start": 575.32,
    "end": 577.32,
    "text": "Again with the first one"
  },
  {
    "start": 579.34,
    "end": 582.92,
    "text": "GCA is actually a segmental disease."
  },
  {
    "start": 583.36,
    "end": 604.72,
    "text": "That means there are inflamed sections and normal section, so if you perform the biopsy that typically harvests one to three centimeters of one temporal artery You will miss the inflamed section."
  },
  {
    "start": 605.18,
    "end": 607.34,
    "text": "So these are skip lesions."
  },
  {
    "start": 608.0,
    "end": 617.28,
    "text": "Contrary, ultrasound evaluates more vessels and along the course of the vessel."
  },
  {
    "start": 617.76,
    "end": 624.2,
    "text": "So there is a higher probability to obtain typical findings."
  },
  {
    "start": 626.98,
    "end": 627.6,
    "text": "Interesting!"
  },
  {
    "start": 628.94,
    "end": 632.84,
    "text": "In this way it's an ultrasound with very good examination."
  },
  {
    "start": 636.24,
    "end": 638.16,
    "text": "When do you perform ultrasound?"
  },
  {
    "start": 639.54,
    "end": 641.32,
    "text": "The earliest possible."
  },
  {
    "start": 642.12,
    "end": 657.64,
    "text": "Corticosteroids treatment should be started as early as possible, so if you performed the ultrasound within first few days You'll see the inflamed section."
  },
  {
    "start": 657.8,
    "end": 662.9,
    "text": "that means the helosine and uncontraceable heloside."
  },
  {
    "start": 664.04,
    "end": 674.38,
    "text": "But If you wait too long, then the yield of the ultrasound as well as the biopsy will decline."
  },
  {
    "start": 676.12,
    "end": 679.86,
    "text": "Okay and of course such other examination?"
  },
  {
    "start": 680.06,
    "end": 685.8,
    "text": "Of course do you have some no bad experience but some pitfalls using ultrason I think or...?"
  },
  {
    "start": 686.86,
    "end": 687.88,
    "text": "Yes of course!"
  },
  {
    "start": 688.42,
    "end": 693.44,
    "text": "You should first this operator dependence...you need a bit."
  },
  {
    "start": 696.76,
    "end": 718.14,
    "text": "Most of all, what is the most important in interpreting The finding Is that it should always be performed In clinical content with the laboratory markers So not after one month or later."
  },
  {
    "start": 719.16,
    "end": 724.2,
    "text": "Therefore you may easily do the wrong diagnosis."
  },
  {
    "start": 724.94,
    "end": 728.88,
    "text": "What is also important in the equipment?"
  },
  {
    "start": 729.34,
    "end": 746.86,
    "text": "You should use ten megahertz probe at least with linear probe, high resolution duplex ultrasonography for performing the ultrasound."
  },
  {
    "start": 748.26,
    "end": 757.38,
    "text": "Then there's of the correct setting."
  },
  {
    "start": 757.6,
    "end": 779.82,
    "text": "That means, for example if you are investigating large vessels then You should have a normal vascular application but If you examine temporal artery you should lower the pulse repetition frequency to obtain better images."
  },
  {
    "start": 780.86,
    "end": 783.76,
    "text": "Okay, there's a very good precision point."
  },
  {
    "start": 784.04,
    "end": 795.1,
    "text": "So you have to use of course high linear probe with high frequency and the good resolution And then off course You have to adapt your PRF."
  },
  {
    "start": 795.36,
    "end": 801.18,
    "text": "so but some false positive that do we have to take in account?"
  },
  {
    "start": 802.5,
    "end": 803.42,
    "text": "Yes, of course."
  },
  {
    "start": 803.88,
    "end": 811.48,
    "text": "At the beginning I said that i will always look for common and internal carotid artery."
  },
  {
    "start": 812.0,
    "end": 823.04,
    "text": "These are frequently all patients though they may have atherosclerosis or age-related or healer wall thickening."
  },
  {
    "start": 823.56,
    "end": 826.9,
    "text": "so we had to take this in account."
  },
  {
    "start": 827.62,
    "end": 840.22,
    "text": "also halo sign is not specific for GCA, but may appear in other basculitis or rare infections involving"
  },
  {
    "start": 842.08,
    "end": 842.22,
    "text": "arteries."
  },
  {
    "start": 842.26,
    "end": 849.9,
    "text": "Okay thank you and the summary if would take a precise definition."
  },
  {
    "start": 850.58,
    "end": 853.68,
    "text": "when do you suspect temporal arthritis?"
  },
  {
    "start": 855.12,
    "end": 866.62,
    "text": "So If have patient with sudden headache new onset headache, but also constitutional symptoms."
  },
  {
    "start": 866.82,
    "end": 924.08,
    "text": "Weight loss, night sweats, scalp tenderness, jaw claudication discomfort during convocation and you see elevated inflammatory markers due to a high risk of complications of permanent visual or stroke or aortic complication, you should start the corticosteroid treatment and confirm you can first perform the confirmation and then start a tree."
  },
  {
    "start": 925.46,
    "end": 937.36,
    "text": "A very precise point because of health is high complication, I think we have to look after that examination as well."
  },
  {
    "start": 937.52,
    "end": 938.54,
    "text": "Thank You so much!"
  },
  {
    "start": 940.5,
    "end": 949.0,
    "text": "To conclude do you have any different therapy strategy if the patient has vision loss or no visual loss?"
  },
  {
    "start": 950.16,
    "end": 951.16,
    "text": "Yes, of course."
  },
  {
    "start": 951.66,
    "end": 969.76,
    "text": "If you have a visual loss for stroke then start DIB, a glucocortico steroids but there is not such symptoms than you will start parallel treatment."
  },
  {
    "start": 970.64,
    "end": 981.76,
    "text": "But what's important You always look for the clinical picture, because later on you will taper to treatment."
  },
  {
    "start": 987.42,
    "end": 999.68,
    "text": "vascular system always at S."
  },
  {
    "start": 1007.56,
    "end": 1011.54,
    "text": "So we just spoken about this condition."
  },
  {
    "start": 1011.88,
    "end": 1024.859,
    "text": "if I really understood that you can confirm better neurologist should learn ultrasound, she'll do ultrasound because it's a not invasive bedside examination."
  },
  {
    "start": 1025.099,
    "end": 1032.119,
    "text": "they could help to make the diagnosis easier by the patient."
  },
  {
    "start": 1063.24,
    "end": 1065.379,
    "text": "This has been EANcast Weekly Neurology."
  },
  {
    "start": 1065.82,
    "end": 1066.58,
    "text": "Thank you for listening!"
  },
  {
    "start": 1067.159,
    "end": 1074.419,
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    "start": 1075.32,
    "end": 1096.639,
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  {
    "start": 1097.379,
    "end": 1098.02,
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    "start": 1099.8,
    "end": 1113.159,
    "text": "E&Cast weekly neurology is your unbiased and independent source of educational research-related neurological content, although all the contents are provided by experts in their field it should not be considered official medical advice."
  }
]