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WRITER: AMY LILLARD
CONTACT: DAVE PEDERSEN
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e-mail: david-pedersen@uiowa.edu

Release:  Oct. 1, 1999

UI dentist warns of disguised disease

IOWA CITY, Iowa -- Cranial arteritis, a condition typically marked by headaches and jaw pain associated with eating, may result in permanent blindness if untreated, a University of Iowa College of Dentistry researcher cautioned.

Cynthia L. Kleinegger, D.D.S., assistant professor in the UI Department of Oral Pathology, Radiology, and Medicine, detailed the disease in an article published in the August 1999 issue of the Journal of the American Dental Association. Kleinegger co-authored the paper with Gilbert E. Lilly, D.D.S., professor and departmental executive officer.

"Since cranial arteritis frequently mimics other disorders, it is easily misdiagnosed and the potential outcome can be devastating," Kleinegger said. "It is important for all health care professionals to be familiar with this condition."

Cranial arteritis is an inflammatory disease that primarily affects cranial arteries and results in decreased blood flow to the tissues they supply. Pain results when functioning muscles do not receive enough blood -- in this case the muscles that move the lower jaw and occasionally the muscles of the throat and tongue. When the blood flow to the visual pathway is decreased, the patient may suffer permanent blindness.

The cause of cranial arteritis is unknown, but there is some evidence of genetic predisposition. Once diagnosed, cranial arteritis is treated with steroids.

The condition occurs primarily in people over age 50, with more than 17 cases per 100,000 individuals discovered each year in that age group. The prevalence increases with age and 850 cases per 100,000 individuals over the age of 85 are diagnosed annually. The frequency of the condition in older people suggests that physicians should seriously consider cranial arteritis when elderly patients complain of headaches and pain associated with eating.

"Since blindness may be sudden in onset, a suspected case of cranial arteritis constitutes a medical emergency," Kleinegger cautioned.

The article described two cases of cranial arteritis in which both patients also exhibited symptoms suggestive of other conditions, such as temporomandibular joint disorder or myofascial pain. In one of the cases, the patient had consulted several healthcare providers, which resulted in a delay of the appropriate diagnosis.

Kleinegger identified a wide variety of symptoms that may be associated with cranial arteritis. Among the key symptoms that could suggest the condition are discomfort associated with eating, typically resolving after chewing is stopped, headaches and a lack of response to treatment for other diagnoses that have been made.

"These symptoms can clue a health care professional to cranial arteritis, but it is important to remember that all the pieces may not be there," Kleinegger said.

Kleinegger said that during her three years as a UI faculty member she has diagnosed two cases of cranial arteritis. Since her paper was published, she has discovered another patient with the condition.