Orbital venography in painful ophthalmoplegia (Tolosa-Hunt syndrome)

Muhletaler, CA; Aj, Gerlock

doi:10.2214/ajr.133.1.31

Cited by 37 publications

(19 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…18,19), which can be visualized on venography. These changes are most often on the side of the painful ophthalmoplegia, but they may be bilateral.…”

Section: Orbital Venous Vasculitis and Cluster Headachementioning

confidence: 99%

Cluster Headache: The Possible Significance of Midline Structures

Sjaastad¹

1988

Cephalalgia

View full text Add to dashboard Cite

The pathogenesis of cluster headache is unknown (see, for example, Ref. 1). With regard to the main component of cluster headache, the pain itself, little information exists both as to the origin and as to the nature of the pain. Existing theories concerning cluster headache pathogenesis have been rather unproductive. In the following, evidence from seemingly totally unrelated fields that, nevertheless, possibly has a bearing on cluster headache pathogenesis will be reviewed. On the tendency to bilaterality in cluster headacheCluster headache is in principle a unilateral headache. There is, however, a tendency for the headache to shift side, either during one single bout (circa 5%) or from one bout to another (circa 10%). All in all, approximately 15% of cluster headache cases thus shift side at some point along the time axis (2). Accordingly, there seems to be a "disposition" or "anlage" for the headache to develop on both sides in cluster headache, although the headache actually most frequently manifests itself on one side only.The prevalence of cluster headache in the form that is severe enough to lead to medical consultations may seem to be around 0.7% (3) in Western countries. The tendency to develop headache on the side opposite the pain side in a cluster headache patient may, therefore, seem to be around 200 times higher than for an individual to develop this type of headache de novo (4). Side shift is thus a conspicuous feature of this disease.On rare occasions, the headache may even be bilateral (5). Several variations of bilaterality have also been observed. Ekbom (6) has thus described a case with a most peculiar pattern, in which the headache during one bout, in addition to appearing on the original side, started appearing on the contralateral side; then "the headache shifted [side] in different attacks"; thereafter, a decrescendo occurred on the original side as opposed to a crescendo on the contralateral side, and, in the ultimate phase, attacks only appeared on the contralateral side.After operations on one side, pain attacks have a tendency to recur on the opposite, previously pain-free side. This was thus the case in 1 of 12 cases treated with the "combined procedure"-that is, sectioning of the greater superficial petrosal nerve and neurolysis of the sensory root of the trigeminal nerve (7).The attack of cluster headache as such consists of (at least) two components: the pain and the autonomic phenomena. The latter also show a tendency to bilaterality (8, 9) and, in fact, much more regularly so than does the pain. In patients with side shift there is sometimes a dichotomy between pain and autonomic phenomena, the latter persisting on the previous pain side (4). The schism may even be primary; that is, the pain has always been contralateral to the autonomic phenomena (10).This tendency to bilaterality in cluster headache is intriguing. A pathogenetic model of cluster headache must also include and explain the marked tendency to bilaterality of the pain and, above all, of the autonomic manifestati...

show abstract

“…18,19), which can be visualized on venography. These changes are most often on the side of the painful ophthalmoplegia, but they may be bilateral.…”

Section: Orbital Venous Vasculitis and Cluster Headachementioning

confidence: 99%

Cluster Headache: The Possible Significance of Midline Structures

Sjaastad¹

1988

Cephalalgia

View full text Add to dashboard Cite

show abstract

“…The case reported by Tolosa showed narrowing of the carotid siphon just distal to the cavernous sinus [24]. Orbital phlebographies revealed abnormalities in a majority of patients: complete ipsilateral occlusion of the superior ophthalmic vein and at least partial obliteration of the cavernous sinus [8,16,21].…”

Section: Introductionmentioning

confidence: 97%

The criteria of the International Headache Society for Tolosa-Hunt syndrome need to be revised

Förderreuther¹,

Straube²

1999

Journal of Neurology

View full text Add to dashboard Cite

In 1988 the International Headache Society defined the diagnostic criteria of Tolosa-Hunt syndrome (THS) to include episode(s) of unilateral orbital pain for an average of 8 weeks if untreated, with associated paresis of one or more of the third, fourth, and sixth cranial nerves. Cranial nerve paresis may coincide with the onset of pain or follow it within a period of up to 2 weeks, and the pain must be relieved within 72 h after the initiation of corticosteroid therapy. Other causative lesions must be excluded by neuroimaging. On the basis of the history and neuroradiological findings of six patients we show the pitfalls in diagnosing THS with these criteria. We propose a revision of the criteria: Other causative lesions must be excluded by neuroimaging, especially of the region of the cavernous sinus and the orbita, and by blood and CSF examinations. Since imaging techniques have dramatically improved, it is now possible to visualize the inflammatory tissue in THS. Positive magnetic resonance imaging or computed tomography findings compatible with inflammatory tissue neither exclude nor confirm THS and remain suspect until a malignant tumor or inflammation other than THS is excluded. Clinical and radiological follow-up examinations must be performed for at least 2 years, even in patients with negative findings on magnetic resonance imaging at onset.

show abstract

“…In THS, orbital venography may demonstrate that the superior ophthalmic vein is occluded on the affected side, and there may be partial or absent filling of the involved cavernous sinus (2,12). Therefore, orbital venography finding can confirm that the responsible lesion for painful ophthalmoplegia is located within the cavernous sinus.…”

Section: Discussionmentioning

confidence: 99%

Isolated Trochlear Nerve Palsy in Tolosa-Hunt Syndrome

et al. 2012

View full text Add to dashboard Cite

A 67-year-old Japanese woman without contributory medical history developed acute onset of left-sided trochlear nerve palsy (TNP) with persistent and severe periorbital pain. There were no other neurological abnormalities. Funduscopic findings were normal. Cranial and orbital magnetic resonance (MR) imaging, and cranial MR angiography demonstrated no abnormalities. By administration of prednisolone 40 mg/day from the day after onset, periorbital pain was resolved within 24 hours, and TNP within 5 days. Thereafter, prednisolone was gradually tapered off. She remained asymptomatic under no medication. In the English language literature, this is the first reported case of Tolosa-Hunt syndrome presenting with isolated TNP.

show abstract

Orbital venography in painful ophthalmoplegia (Tolosa-Hunt syndrome)

Cited by 37 publications

References 7 publications

Cluster Headache: The Possible Significance of Midline Structures

Cluster Headache: The Possible Significance of Midline Structures

The criteria of the International Headache Society for Tolosa-Hunt syndrome need to be revised

Isolated Trochlear Nerve Palsy in Tolosa-Hunt Syndrome

Contact Info

Product

Resources

About