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Critical Situations
July 1999

Magnetic Resonance Angiography in the Diagnosis of a Case of Giant Cell Arteritis Manifesting as Scalp Necrosis

Arch Dermatol. 1999;135(7):769-771. doi:10.1001/archderm.135.7.769

An 81-year-old-man presented to our clinic with 2 family members reporting the appearance 4 months earlier of 2 ulcers on his scalp that had slowly enlarged. The patient and his family denied any other systemic signs or symptoms and had not noticed the appearance of any other cutaneous lesion. Examination revealed 2 extensive ulcers covered with thick and adherent crusts, symmetrically located on both temporoparietal areas of the scalp (Figure 1). Both ulcers had a triangular shape and well-demarcated, deep margins. The right ulcer measured 9×5 cm, and the left, 11×6 cm. The patient reported intense pain at the slightest touch, and his relatives, after direct questioning about headaches, explained that he had been taking several tablets daily of an over-the-counter analgesic for the last 6 months because of intense and almost continuous headaches that neither they nor the patient had considered related to the skin lesions. The rest of the physical examination revealed no other skin lesions, and we could not palpate a cord or feel any bruit on the temporal artery; the patient was apyretic.

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