A 68-year-old female presents to the emergency department complaining of a new onset, severe headache localized to her left temple. She also reports jaw claudication and visual disturbances. Which of the following is the most appropriate initial diagnostic test?
Lumbar puncture
Complete Blood Count (CBC)
CT scan of the head
Erythrocyte Sedimentation Rate (ESR)
The correct answer is Erythrocyte Sedimentation Rate (ESR). This scenario strongly suggests temporal arteritis, also known as giant cell arteritis. The classic presentation includes new onset headache in an older adult, often with jaw claudication and visual disturbances. ESR is typically the initial diagnostic test ordered when temporal arteritis is suspected, as it is highly sensitive for inflammation.
While a CT scan might be considered to rule out other intracranial pathologies, it is not the most appropriate initial test for suspected temporal arteritis. Similarly, a lumbar puncture would be more appropriate for suspected meningitis or subarachnoid hemorrhage. A complete blood count (CBC) may show anemia or thrombocytosis in temporal arteritis, but it is not as specific or sensitive as ESR for this condition.
It's important to note that if temporal arteritis is strongly suspected, treatment with high-dose corticosteroids should be initiated promptly, even before the diagnosis is confirmed, to prevent potential vision loss.
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