Ashton-Key M, Gallagher P J
Baillieres Clin Rheumatol. 1991 Dec;5(3):387-404. doi: 10.1016/s0950-3579(05)80061-5.
In both clinical and histological terms cranial arteritis is one of the most distinctive of all vascular disorders. The dense granulomatous inflammatory infiltrates which characterize the acute stages of the disease resemble those of Takayasu's arteritis or granulomatous angiitis of the central nervous system, but the clinicopathological features in patients with positive temporal artery biopsies are diagnostic. Well over a third of patients with classical signs and symptoms of cranial arteritis have negative temporal artery biopsies, and focal involvement of arteries of the head and neck is the probable explanation for this. Pathologists should be aware of the wide spectrum of histological changes that occur in muscular arteries as part of normal ageing and must not interpret these as evidence of healed arteritis. The histological changes of healed arteritis include medial chronic inflammation with ingrowth of new blood vessels, focal medial scarring and a bizarre pattern of intimal fibrosis. Although ultrastructural and immunohistochemical studies have provided some insight into the underlying pathological changes, they have not contributed directly to the diagnosis of cranial arteritis. Between 15 and 55% of patients with polymyalgia rheumatica have positive temporal artery biopsies, but apart from an elevated ESR there are no other laboratory investigations or biopsy procedures that contribute to diagnosis.
从临床和组织学角度来看，颅动脉炎是所有血管疾病中最具特征性的疾病之一。该疾病急性期特征性的致密肉芽肿性炎性浸润类似于高安动脉炎或中枢神经系统肉芽肿性血管炎，但颞动脉活检阳性患者的临床病理特征具有诊断意义。超过三分之一有颅动脉炎典型体征和症状的患者颞动脉活检为阴性，头颈部动脉的局灶性受累可能是其原因。病理学家应了解肌肉动脉中作为正常衰老一部分而出现的广泛组织学变化，且绝不能将这些变化解读为愈合性动脉炎的证据。愈合性动脉炎的组织学变化包括伴有新生血管长入的中膜慢性炎症、局灶性中膜瘢痕形成以及内膜纤维化的奇异模式。尽管超微结构和免疫组织化学研究对潜在的病理变化有一定了解，但它们对颅动脉炎的诊断没有直接帮助。15%至55%的风湿性多肌痛患者颞动脉活检呈阳性，但除血沉升高外，没有其他实验室检查或活检程序有助于诊断。
