Tongue necrosis in a patient with cranial arteritis.

Cranial Arteritis (CA) is a giant cells vasculitis of unknown cause, which preferentially involves the extracranial branches of the carotid artery. It is the most common systemic vasculitis in adults . Age is its major risk factor, and it affects patients above 50 years of age. CA’s classic manifestations are headache, mandibular claudication, rheumatic polymyalgia and visual symptoms. Headache is the most common finding in about 70% of the patients affected. Rheumatic polymyalgia is usually seen as the systemic stage in CA, characterized by pain in the shoulders, neck and hips. Visual symptoms such as vision loss and diplopia happen to one third of the patients. Blindness is the most feared complication. Systemic symptoms such as weight loss, fever and arthralgia are common. In 40% of the patients there are atypical otorhinolaryngological symptoms such as dry cough, sore throat, dysphonia, neck pain and tongue involvement. Tongue involvement is not uncommon, the main complaints are paresthesias, pain, glossitis and tongue claudication. Despite all of these, tongue necrosis and ischemia are rare events. Diagnosis is based on clinical history, physical exam and an increase in the erythrocyte sedimentation rate (ESR), which is usually higher than 100 mm/h. In the patient’s exam we can find anomalies in the temporal artery such as pulsation increase or interruption. Diagnosis is confirmed by temporal bone biopsy, which shows mononuclear infiltration or granulomatous inflammation.