Young Woman with Progressive Temporal Pain and Vascular Abnormalities

Case at a Glance

A 30-year-old woman presented with progressive right temporal pain and was found to have multifocal mild stenosis in the right superficial temporal artery on CT angiography, raising concerns for temporal arteritis despite her young age.

Patient's Story

The patient initially experienced brief episodes of sharp pressure in her right temple lasting approximately one minute. Over the course of a year, these episodes became more frequent and intense, prompting her to seek medical attention. The pain was localized to the right temporal region and had a pressure-like quality that was becoming increasingly bothersome.

Initial Assessment

The patient was evaluated by a neurologist who suspected possible temporal artery involvement based on her symptoms. Given the clinical presentation, CT angiography was ordered to evaluate the intracranial and extracranial vasculature. The neurologist noted that while the symptoms were suggestive of temporal arteritis, this diagnosis would be atypical given the patient's young age.

The Diagnostic Journey

CT angiography revealed several key findings: diffuse small caliber intracranial vessels with mild stenosis in the A1 segment of the right anterior cerebral artery, anatomic variants in intracranial arteries, and most notably, multifocal mild stenosis in the visualized portion of the right superficial temporal artery. The radiologist noted that while the differential diagnosis included temporal arteritis, other vasculitis, and atherosclerosis, these findings were atypical for the patient's age. The patient was subsequently referred to rheumatology for further evaluation, but this consultation did not yield additional diagnostic clarity.

Final Diagnosis

The case remains diagnostically challenging with imaging findings suggestive of vascular involvement, particularly of the right superficial temporal artery, but without definitive diagnosis due to atypical age presentation and incomplete workup.

Treatment Plan

Further evaluation was recommended including Doppler ultrasound of the temporal arteries, comprehensive laboratory studies including inflammatory markers (ESR, CRP), and correlation with clinical history. Additional rheumatologic workup may be warranted to rule out systemic vasculitis or other inflammatory conditions.

Outcome and Follow-up

The patient's symptoms continued to progress despite initial evaluations. The case highlights the importance of not dismissing vascular inflammatory diseases based solely on age, and the need for comprehensive evaluation including advanced imaging, laboratory studies, and possibly tissue biopsy when clinical suspicion remains high despite atypical presentations.