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Tolosa-Hunt综合征的临床特点、影像学研究及病因分析
引用本文:管小亭,于学英,藏大维,沈言修,尚京伟,何雁. Tolosa-Hunt综合征的临床特点、影像学研究及病因分析[J]. 中华神经科杂志, 2001, 34(5): 280-282,I003
作者姓名:管小亭  于学英  藏大维  沈言修  尚京伟  何雁
作者单位:1. 首都医科大学附属天坛医院神经内科,北京 100050
2. 北京市神经外科研究所神经影像室
摘    要:
目的 研究Tolosa-Hunt综合征(THS)的临床表现、影像学检查结果,进一步证明其病因为非特异性炎症。方法 回顾总结1985年5月至2000年10月所收治的28例THS住院患者的临床表现、病理及影像学检查结果并结合文献进行病因分析。结果 28例患者头痛形式、部位及程度个体差异较大,颅神经受损数量为1-5支;复发较常见,激素治疗效果明显,但可留有颅神经麻痹后遗症。1例病理结果显示,镜下可见病灶内大量淋巴细胞、浆细胞及胶原纤维,未见肿瘤而细胞,病理诊断为炎性肉芽肿。神经影像学检查:首次CT检查27例,6例显示海绵窦区病变;MRI检查21例,12例显示海绵窦区病变;数字减影血管造影术(DSA)检查12例,5例显示海绵窦区病变。复查时,首次CT或MRI阴性的12例中4例出现海绵窦区病变;首次CT或MRI阳性的12例中10例病灶明显减小或基本消失。CT及MRI增强扫描显示病灶表现均匀一致的强化。结论 综合分析临床表现、病理学检查、影像学检查和激素治疗效果,进一步证明了THS的病因为非特异性炎症。对影像学表现不典型和激素治疗效果不明显者,应定期进行临床和影像学复查,有利于提高诊断率和制定治疗方案。

关 键 词:痛性眼肌麻痹综合征 海绵窦 病因学 Tolosa-Hunt综合征 临床特点 影像学研究 诊断标准

Study on the etiology and neuroimaging examinations of Tolosa-Hunt syndrome
GUAN Xiaoting,YU Xueying,ZANG Dawei,e t al. Study on the etiology and neuroimaging examinations of Tolosa-Hunt syndrome[J]. Chinese Journal of Neurology, 2001, 34(5): 280-282,I003
Authors:GUAN Xiaoting  YU Xueying  ZANG Dawei  e t al
Affiliation:GUAN Xiaoting~*,YU Xueying,ZANG Dawei,e t al.* Department of Neurology,Capital University of Medical Science Affiliate d Ti antan Hospital,Beijing 100050,China
Abstract:
Objective To study the clinical manifestation and neuroimaging findings and further to pro ve the etiology of nonspecific inflammation of Tolosa-Hunt syndrome(THS). Methods The clinical manifestation,pathological,neuroimaging a nd pathological data of such 28 cases hospitalized from May 1985 to October 2000 and literatures were retrospectively reviewed. Results The type,the site and t he severity of the headache were shown greatly different individually. The relapse often occurred.The number of the involved cranial nerves varied from 1 to 5 branches.The treatment using corticosteroid was effective but some of th e m were resulting in cranial nerve paralysis. One was operation case in which t h e histologic study showed a number of lymphocytes,plasmocytes and collagenous f ibers,but no tumor cells. Pathological diagnosis showed an inflammatory granu l oma. Neuroimaging examinations: CT scans in 6 of 27 showed cavernous sinus lesi o n (CSL).MRI scans in 12 of 21 cases showed CSL.DSA in 5 of 12 showed CSL. Fol low -up Eexaminations: CT and MRI in 4 of 12 having negative results in the first time examination showed CSL. The CSL both in CT and MRI in 10 of 12 having posi t ive results by the first time examination had obviously diminished or disappeare d. The CSL both in CT and MRI were homogeneously well-enhanced. Co nclusions T he study showed that,the etiology of nonspecific inflammation was supported again . In this article the follow-up study both on clinical and neuroimaging examinat i ons for those atypical and not completely recovered was carried out as to maki ng sure the etiology and further therapy.
Keywords:Tolosa-Hunt syndrome  Cavernous sinus  Etiology
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