Should I do a bilateral or unilateral temporal artery biopsy in suspected giant cell arteritis?

Wayne T Cornblath In neuroophthalmology there are very few true emergencies (aneurysmal third nerve palsy, rapidly progressive optic neuropathy from papilledema, thyroid eye disease or pituitary apoplexy, all come to mind). However, the number one neuroophthalmic emergency has to be giant cell arteritis (GCA). GCA has many different manifestations from diplopia to visual loss to scalp lesions, with or without constitutional symptoms. Up to 40% of patients lose vision, and up to three quarters of the 40% lose vision in the both eyes.(1) Yet the treatment of GCA, oral corticosteroids for a year or more, is not without morbidity, particularly given the age range in which GCA occurs. These confounding data points, risk of permanent visual loss versus toxicity of treatment, make obtaining a definitive diagnosis of GCA critical.