The evaluation of ICHD-3 beta diagnostic criteria for Tolosa–Hunt syndrome: a study of 22 cases of Tolosa–Hunt syndrome

Abstract

The objective of the study was to evaluate the amended International Classification of Headache Disorders (third edition, beta version, ICHD-3 beta) with a retrospective analysis. A total of 22 patients diagnosed with painful ophthalmoplegia and Tolosa-Hunt syndrome (THS) in our hospital were retrospectively studied. The following clinical data were collected: symptoms, signs, location of inflammatory tissue, time interval of paresis following the onset of pain, pain and signs of resolution, follow-up and relapse. Pain and diplopia were found in 22 (100 %) and 20 cases (91 %). The sympathetic nerve was involved in 6 cases (27 %). Paresis followed the pain for an average of 8 ± 5.87 days. Serial magnetic resonance imaging (MRI) revealed granulomatous lesion that was visible in 20 patients (91 %). 19 patients (86 %) demonstrated the lesions located in the cavernous sinus, orbital apex or superior orbital fissure. One lesion extended to the intracranial structure. Pain was relieved in 20 cases (91 %) within 72 h and no patient had complete relief from paresis. According to our study, we think the time course of relief should be undefined. Headache location is hard to describe accurately. Normal MRI should be involved in THS diagnoses. The lesion of THS can extend beyond the cavernous sinus and the orbit. The time interval between headache and paresis can exceed 2 weeks.

The Value of Enhanced Three-dimensional Brain volume magnetic Resonance Imaging in tolosa-hunt Syndrome: A Clinical Retrospective Study

“…Studies suggested thin the slice thickness and enhanced MRI with fat suppression maybe another option. [12]An observation by applying high resolution MR sequences(slice thickness = 2.5-3 mm), from Schuknecht and his colleagues, displayed 75% pathologic nding. [13] Hao gave post-contrast fat suppression MRI scans to the "non-enhanced MRI negative" patients.…”

A case of delirium in Tolosa-Hunt syndrome during corticosteroid therapy

“…THS can be treated with corticosteroids, with the disappearance of eye pain within a number of days (approximately 1 to 4 days) and alleviation of ophthalmoplegia within a number of weeks (7 to 60 weeks) from the start of treatment [5,8]. The patient in this case received intravenous methylprednisolone at 1000 mg/day for 3 days as steroid pulse therapy and then started receiving oral prednisolone at 60 mg/day.…”

“…Although a straightforward dose-response effect on psychiatric adverse reactions has not yet been elucidated, these reports suggest that a prednisolone dose less than 40 mg/ day might safely prevent these reactions. Steroid therapy for THS currently lacks any protocol-specified dosage; accordingly, corticosteroid therapy involves varied doses, methods, and durations (Table 1) [2][3][4][5][6][7][8]. An initial prednisolone dose of 1.0 to 1.5 mg/kg/day is commonly found in available reports.…”

“…The pain and paresis in THS resolve when adequately treated with corticosteroids [1]. However, previous reports showed that there is no definitive protocol for the dose, method, or duration of corticosteroid therapy in THS, and most of these factors depend on practice at the managing hospital or the judgment of the attending physician [2][3][4][5][6][7][8].…”

Facial pain: Overlapping syndromes

“…Some reported cases of Tolosa-Hunt syndrome had additional involvement of the fifth nerve (commonly the first division) or optic, seventh, or eighth nerve. Sympathetic innervation of the pupil is affected in about 30% of patients (20). Most cases are unilateral, but rarely are also bilateral.…”