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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
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Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Temporal Arteritis relapse or concussion? Diagnosed with PMR

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Temporal Arteritis relapse or concussion?
Diagnosed with PMR and TA February 2013. Prednisone was magic in resolving symptoms. Very gradual taper (now at 15mg). I sustained a concussion 6 weeks ago. Unfortunately, hit temple exactly where the temporal arteritis pain had been situated. Over the first few weeks post concussion the headaches and other symptoms improved. Then, suddenly, 5 days ago the temple pain went nuts. Really really painful and even prednisone doesn't help. Vision symptoms (like I had in first weeks of concussion) in one eye only (looking at type right now it is vibrating and gives a shadow/double effect). And (brand new symptom) when I move my jaw-- talking, eating, laughing, I get horrible temple pain (same place as the headache, same pain). Rest doesn't help the headache (tried two days of full mental and physical rest, like for concussion, with no real improvement). Not talking or chewing does help the jaw pain but doesn't make it go away

Had a normal CT two weeks ago. Cognitive and balance related concussion symptoms are much improved.

Phoned GP today and she things, to be safe, we should increase my prednisone to 30 and even 35 or 40 if no improvement after a few days. Rheumatologist appt not available for months. I don't want to increase my dose (not because the high dose was a problem, few side effects, but the taper was horrid).

The questions: Could this 'just' be the concussion? Can I increase the dose of prednisone for a week trial and then go right down to the lower level if it does nothing? Are relapses of TA likely and what is the prognosis? f I don't increase my dose, is 15 mg enough to keep me from serious TA impact?

Dr. Dan B. : Hello and thanks for your question. Are you available to chat?
Dr. Dan B. : First of all, well technically this could be related to the concussion, I strongly suspect that it is not but instead is related to the temporal arteritis. And given how severe the consequences can be, you have to assume it is from temporal arteritis and not from the concussion.
Dr. Dan B. : I agree with your GP. However I don't agree that it is safe to just increase it for a week and then taper back down. Yes, relapses are certainly possible especially during a tapering of the prednisone. And since you are only six months out from the initial onset, relapses are still very likely.
Dr. Dan B. : If you can keep the inflammatory markers in your blood at a low level through the prednisone use, temporal arteritis usually will burn itself out after 1 to 2 years and the prognosis is usually good as long as it is controlled through the duration. But no, 15 mg is quite unlikely to prevent serious sequela from temporal arteritis. Does this make sense? Do you have any other questions about this?
Dr. Dan B. : It appears as though you are not in the chat room currently. I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need. If you would like to ask further questions or clarification regarding anything I've said, please let me know and I will be happy to address your concerns when I return to see if you've responded. If your concerns have been resolved...Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied. My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!

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