A 60-year-old female presents with a 3-week history of severe unilateral temporal headache, jaw claudication while chewing, and low-grade fever. Erythrocyte sedimentation rate (ESR) is markedly elevated at 98 mm/hr. What is the most urgent management step to prevent permanent irreversible vision loss?

Answer and explanation

Correct answer: D. Immediate high-dose systemic corticosteroid therapy

  1. Step 1: Recognize giant cell arteritis (temporal arteritis): Unilateral headache, jaw claudication, elderly patient, high ESR.
  2. Step 2: Due to the imminent risk of anterior ischemic optic neuropathy and permanent blindness, high-dose systemic corticosteroids (prednisone 40-60 mg daily or IV methylprednisolone) must be initiated immediately, without waiting for the confirmatory temporal artery biopsy.
Answer
Immediate high-dose systemic corticosteroid therapy.
Why not the others: 'Waiting for temporal artery biopsy' risks permanent bilateral blindness while awaiting pathology; 'Oral NSAIDs' do not prevent ischemic arterial occlusion; 'CTA of the head' cannot replace tissue biopsy or emergency steroid administration.

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