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exogenous antigen induces antibodies that attach to the primary target (the vessel wall) as immune complexes, damage it, and attract lymphocytes and mononuclear cells The giant cells form around remnants of the vessel wall (elastic tissue, etc) An acute necrotizing cerebral angiitis which may be idiopathic, sometimes complicates ulcerative colitis, and responds to treatment with prednisone and cyclophosphamide may also belong in this category The special case of intravascular lymphoma, which simulates a cerebral vasculitis, is discussed in Chap 31 Temporal Arteritis (Giant-Cell Arteritis, Cranial Arteritis; See also page 159) In this disease, not uncommon among elderly persons, arteries of the external carotid system, particularly the temporal branches, are the sites of a subacute granulomatous in ammatory exudate consisting of lymphocytes and other mononuclear cells, neutrophilic leukocytes, and giant cells The most severely affected parts of the artery usually become thrombosed.

ollecting the information to revise this book required the help of many people and organizations. Not only did the task entail covering eight types of education careers, it also involved gathering details on subcategories of those careers. For the rst time, we had substantial assistance from the websites of organizations, agencies, and associations. Websites were easy to access, well developed, and loaded with information. In many cases we missed contact with live people. That was a new experience, both ef cient and convenient but also dehumanizing. Talking with representatives of organizations always has yielded unexpected information, unusual ideas, and the enthusiasm and the commitment that people convey about their specialty. Nevertheless, we had numerous conversations with real people in many of the jobs we explored. So we did not miss out entirely on the richness of personal contact, and we appreciate the research assistance of Valerie Smith. We are deeply indebted to all the people and organizations that contributed information and ideas. We hope that the book promotes information and interest for those considering a career in education. This edition contains a new feature in each chapter: a rsthand account from a person who has been there, done that in the career being described. We list all the contributors below and express our gratitude to them for sharing their perceptions.

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The sedimentation rate is characteristically elevated above 80 mm/h and sometimes exceeds 120 mm/h, but a small number of cases occur with values below 50 mm/h Headache or head pain is the chief complaint, and there may be severe pain, aching, and stiffness in the proximal muscles of the limbs associated with the markedly elevated sedimentation rate Thus the clinical picture overlaps that of polymyalgia rheumatica as discussed in Chap 10 Other less frequent systemic manifestations include fever, anorexia and loss of weight, malaise, anemia, and a mild leukocytosis Instances of dementia, depression, and other neurologic illnesses that have been described in the literature in patients with temporal arteritis seem to us coincidental Occlusion of branches of the ophthalmic artery, resulting in blindness in one or both eyes, is the main complication, occurring in over 25 percent of patients.

In the most extreme form, the optic nerve head can be seen to be infarcted, with papilledema and visual loss This is a form of anterior ischemic optic neuropathy discussed in Chap 10 In a few cases blindness is preceded by transient visual loss simulating a TIA Occasionally the arteries of the oculomotor nerves are also involved, causing an ophthalmoplegia Rarely, an arteritis of the aorta and its major branches including the carotid, subclavian, coronary, and femoral arteries is found at postmortem examination Signi cant in ammatory involvement of intracranial arteries from temporal arteritis is uncommon, perhaps because of a relative lack of elastic tissue, but in a few cases strokes have occurred on the basis of occlusion of the internal carotid or vertebral arteries.

The diagnosis should be suspected in elderly patients who develop severe, persistent headache and elevation of the sedimentation rate; it depends on nding a tender, thrombosed, or thickened cranial artery and demonstration of the lesion in a biopsy The procedure is innocuous and the diagnosis may require that both sides be sampled because of the patchy distribution of granulomatous lesions Schmidt and colleagues have reported that the diagnosis can often be made with duplex ultrasonography In 22 of 30 cases, a dark halo, probably re ecting edema, surrounded the affected temporal artery; 6 cases showed either occlusion or stenosis of the artery; there were no false-positive tests A considerable length of the temporal artery can be insonated by this technique, a particularly useful feature in a process that affects the vessel segmentally From our limited experience, these ndings have proven dif cult to detect.

The arteritic changes may also be revealed by arteriography of the external carotid arteries The administration of prednisone, 50 to 75 mg/day, provides.

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