Tolosa-Hunt syndrome - diagnostic problem of painful ophthalmoplegia

Paović, Jelena; Paović, Predrag; Bojkovic, Ivica; Nagulić, M; Sredovic, Vojislav

doi:10.2298/vsp1207627p

Cited by 20 publications

(16 citation statements)

References 34 publications

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“…This produces either partial or complete ophthalmoplegia, ptosis and orbital/periorbital/hemicranial pain 4. Inflammation usually originates in the cavernous sinus, and extends forward to involve the superior orbital fissure and orbital cavity.…”

Section: Discussionmentioning

confidence: 99%

Tolosa-Hunt syndrome: an arcane pathology of cavernous venous sinus

et al. 2015

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Tolosa-Hunt syndrome, an idiopathic granulomatous inflammation of the cavernous sinus, is primarily a diagnosis of exclusion. The majority of patients present with unilateral orbital pain and features suggestive of paralysis of one or more of the cranial nerves passing through the cavernous sinus and/or superior orbital fissure. MRI of the head may show unilateral enhancement of the cavernous sinus and orbital apex. Treatment is with high-dose intravenous steroids followed by tapering oral steroids. Rapid amelioration of pain within 24–48 h supports this rare diagnosis. Resolution of neuropathies may take longer. We describe a case of a young man who presented with left periorbital pain, complete ophthalmoplaegia and ptosis of the left eye. MRI showed enhancement of the left cavernous sinus and orbital apex. High dose steroids led to complete resolution of pain, while ptosis and ophthalmoplaegia improved gradually.

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Section: Discussionmentioning

confidence: 99%

Tolosa-Hunt syndrome: an arcane pathology of cavernous venous sinus

et al. 2015

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“…Kavernöz sinüs içindeki herhangi bir sinirin tutulumuyla nörolojik bulgular ortaya çıkar. 4 En sık etkilenen üçüncü kraniyal sinir olmakla beraber diğer oküler motor sinirler ile beşinci kraniyal sinirin oftalmik ve maksiller dallarının tutulumu eşlik edebilmektedir. Periarteriyel sempatik lifler ve optik sinir de tutulabilir.…”

Section: Discussionunclassified

“…THS'nin kollajen hastalıklarla (temporal arterit, PAN), kavernöz karotid anevrizmasıyla, diyabet, lenfoma, karsinom, psödotümör orbita, menenjiyom ve oftalmoplejik migrenle ayırıcı tanısı yapılmalıdır. 4 Psödotümör orbita, orbital ağrı, oftalmopleji, kemozis ve proptozis ile seyreden akut difüz orbital inflamasyondur. THS'de proptozis gö-rülmemesi ve beşinci kraniyal tutulumunun olabilmesi psödotümör orbitadan ayrımında yardımcı olan bulgulardır.…”

Section: Discussionunclassified

A Case of Tolosa-Hunt Syndrome

Biçer¹,

Acar²,

Çalışkan³

et al. 2015

Turkiye Klinikleri J Ophthalmol

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“…MRI orbital phlebography and biopsy are the recommended methods for making diagniosis. [3] The clinical presentation of THS has a wide differential diagnosis, can Herein we report a 45-year-old women with painful ophthalmoplegia of the left eye secondary to the THS, it's diagnostic procedures and treatment.…”

Section: Introductionmentioning

confidence: 98%

Painful Ophthalmoplegia: A Case Report And Literature Review

Özkan

2015

Agri

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OCTOBER 2015219 ÖzetAğrılı oftalmopleji periorbital veya hemikranyal başa ağrısı ile beraber ipsilateral okular motor sinir parezileri ile karakterizedir ve birçok değişik etiyoloji sonucu oluşabilir. Tolosa-Hunt Sendromu (THS) ağrılı oftalmopatiye neden olabilen, kavernöz sinus, superior orbital fissur ve orbat apeksinin nonspesifik inflamasyonu sonucu oluşan nadir bir hastalıktır. Burada sol göz ağrısı ve diplopi ile başvuran 45 yaşında kadın hasta sunuldu. Muayenesinde periorbital ödem ve sol palpebral semiptoz, sol parsiyel 3. kranyal sinir felci, 4., 6. felci ve 5. sinir oftalmik ve maksiller divizyon alanında hiposetezi saptandı. Kan analizi, postkontrast kraniyal ve orbital magnetik resonans görüntülemesi ve BOS incelemesinde patoloji saptanmadı. Klinik tanısı THS kriterlerini dolduruyordu. Steroid tedavisi sonrası semptom ve bulguları tamamen düzeldi. Ağrılı oftalmopleji THS gibi enflamatuvar durumlar ile birlikte olabilir ve bu durumda steroid tedavisine tam aynıtlıdır, fakat mutlaka iyi bir ayırıcı tanı yapılmalıdır. THS tanısı nadiren kullanılması gereken bir tanıdır.Anahtar sözcükler: Multipl kraniyal sinir felci; ağrılı oftalmopleji; Tolosa-Hunt sendromu. SummaryPainful ophthalmoplegia consists of periorbital or hemicranial pain with ipsilateral ocular motor nerve palsies. There are many etiologies of painful ophthalmoplegia. Tolosa-Hunt syndrome (THS) is an uncommon disease caused by non-specific inflammation of the cavernous sinus, superior orbital fissure and the apex of the orbit. A 45-year-old female reported episodes of reversible left eye pain and diplopia. Examination showed periorbital oedema and left palpebral semiptosis, paresis of the partial left third nerve palsy with normal pupillary reactions, fourth and sixth left cranial nerves, and hypoesthesia over the first and second division of the left trigeminal nerve. Blood analysis, postcontrast cranial and orbital magnetic resonance (MR) imaging, cranial MR angiography and CSF analysis demonstrated no abnormalities. The clinical diagnosis satisfies the criteria for THS. After steroid therapy her symptoms and clinical signs dramatically reverses. Painful ophthalmoplegia with inflammatory conditions such as THS is highly responsive to corticosteroids but should be diagnoses of exclusion. The THS diagnosis should be used rarely and with great caution.

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Tolosa-Hunt syndrome - diagnostic problem of painful ophthalmoplegia

Cited by 20 publications

References 34 publications

Tolosa-Hunt syndrome: an arcane pathology of cavernous venous sinus

Tolosa-Hunt syndrome: an arcane pathology of cavernous venous sinus

A Case of Tolosa-Hunt Syndrome

Painful Ophthalmoplegia: A Case Report And Literature Review

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