痛性眼肌麻痹综合征的MRI诊断

目的 探讨痛性眼肌麻痹综合征在磁共振成像（magnetic resonance inaging,MRI）中的表现,为痛性眼肌麻痹综合征的临床诊断提供客观的影像学依据。方法 对临床确诊的17例痛性眼肌麻痹综合征患者,分别行眶区和（或）海绵窦区MRI平扫和脂肪抑制钆-二乙烯三胺五乙酸（gadolinium-diethylene triamine pentaacetic acid,Gd-DTPA)增强扫描。结果 痛性眼肌麻痹综合征MRI表现为眶上裂区斑片状或小结节状异常信号,患者海绵窦增大、增宽,眶上裂和海绵窦邻近的颞叶脑膜局限性受累。结论 MRI脂肪抑制Gd-DTPA增强扫描可清晰显示痛性眼肌麻痹综合征的病变;MRI检查可为临床诊断痛性眼肌痹综合征提供客观、可靠的影像学依据。     

痛性眼肌麻痹综合征的临床分析

目的 探讨痛性眼肌麻痹综合征的病因、临床特点、诊断及治疗。 方法 回顾2000年月至2005年８月所收治的12例痛性眼肌麻痹综合征住院患者的起病情况、临 床表现、实验室检查、影像学检查及治疗，并结合文献进行分析讨论。 结果 12例患者头痛性质、程度等表现多样化。颅神经受累以Ⅲ、Ⅳ、Ⅴ1-2、Ⅵ多见，尤以第Ⅲ颅神经受累最多，占83.3% ，常见几支颅神经同时受累，占75%。诊断需排除其它可引起头痛及眼肌麻痹的疾病。影像学检查可帮助诊断，皮质类固醇激素治疗效果显著，本组治愈率达75%。 结论 痛性眼肌麻痹综合征患者的临床表现、影像学检查以及对皮质类固醇激素治疗反应敏感的特点，均与非特异性炎性肉芽肿之病因相符合。明确诊断后，糖皮质激素治疗有效。 （中华眼底病杂志，2006，22：385-386）     

痛性眼肌麻痹的研究进展

痛性眼肌麻痹综合征（painful ophthamoplegia syndrome）亦称Tolosa-Hunt综合征（THS）,是一种缓解和复发的一侧Ⅲ,Ⅳ,Ⅵ脑神经之一或同时受累,从而造成眼肌麻痹,并伴有眼眶部疼痛的一组症候群。其病因不明,可能为免疫缺陷性反应,也有学者认为其是眶上裂的非特异性炎症或与血管性病变有关。该病依神经受影响之范围大小、程度轻重,其眼部症状有各种表现。痛性眼肌麻痹综合征在临床上少见,易与眼肌麻痹性头痛相混淆,临床诊断有一定的困难,治疗上对肾上腺皮质激素有效。本文旨在对痛性眼肌麻痹综合征的病因、临床特点、诊断、鉴别诊断和治疗进行综述如下。     

痛性眼肌麻痹合并眼眶炎性假瘤及双眼球后视神经炎

痛性眼肌麻痹又称Tolosa—Hunt 综合征。系由海绵窦及眶上裂炎症引起,以严重眼痛合并眼肌麻痹为临床特点,主要表现为Ⅲ、Ⅳ、Ⅴ、Ⅵ颅神经受累的眶上裂综合征。本文报告1例典型痛性眼肌麻痹合并眼眶炎性假瘤及双侧性球后视神经炎,并对其临床及病理特点进行讨论。     

63例Tolosa-Hunt综合征临床分析

目的 探讨Tolosa-Hunt综合征(THs)的诊断、鉴别诊断及治疗,以提高该病的诊疗水平.方法 回顾性研究1996.2006年临床确诊的63例THS,分析其临床特点、实验室检查、影像学表现、治疗效果及预后.结果 63例患者中多为急性、亚急性起病,均有头痛和眼肌麻痹,大多数以动眼神经损伤为主,部分呈动眼神经完全损伤,Ⅲ、Ⅳ、Ⅵ颅神经同时受累较多见,可伴有视神经损伤,经CT、MRI排除其他疾病,激素治疗有效.结论 痛性眼肌麻痹综合征可能因非特异性炎症引起,相关实验室检查、影像学检查有一定价值,激素治疗敏感.     

眼肌麻痹60例临床分析

目的:探讨眼肌麻痹的病因和临床特点。方法:对眼科收治的60例眼肌麻痹患者的临床资料进行回顾性分析。结果:眼肌麻痹患者60例中,血管病性27例(45%),外伤性15例(25%),其它原因者13例(22%),原因不明5例(8%)。结论:眼肌麻痹病因复杂,根据发病年龄、起病方式、伴随症状等临床表现,同时完善相关检查,多数眼肌麻痹不难诊断。     

Tolosa-Hunt综合征的临床分析

Tolosa-Hunt综合征(THS)在临床上属于少见病,是由于海绵窦区(有时病变范围波及眶上裂甚至眶尖)非特异性炎性肉芽肿所致的痛性眼肌麻痹。THS临床特征为眶周或眼眶后疼痛同时伴有单根或多根眼外肌麻痹以及同侧三叉神经感觉区障碍。临床上表现为痛性眼肌麻痹的疾病有很多(眼肌麻痹性偏头痛、海绵窦段颈内动脉瘤、脑膜炎、糖尿病致颅神经损伤及鼻咽癌所致的痛性眼肌麻痹等),容易造成诊断上的困难,本文对于THS病因、临床特点、诊断标准、鉴别诊断以及治疗原则做了综合性的论述,同时着重介绍了MRI对于诊断THS的重要性。     

糖尿病性眼肌麻痹17例临床分析

糖尿病是一种终身性内分泌疾病 ,有较多并发症可累及人体多个器官。糖尿病性眼肌麻痹是其较为少见的并发症。我院眼科 1 992年4月至 1 999年 2月共收治 1 7例。报告如下 :临床资料1 一般资料 :1 992年 4月至 1 999年 2月我科共收治后天性眼肌麻痹患者 2 4例。其中 :痛性眼肌麻痹 2例 ,内眼手术后眼肌麻痹 3例 ,原因不明 2例 ,糖尿病性眼肌麻痹 1 7例 ,占总数的 71 %。该 1 7例患者中 ,男 1 1例 ,女 6例 ,年龄 5 3 -72岁 ,平均 63 5岁 ;既往有糖尿病史 1 6例 ,病程 4-2 3年 ,平均 7 1年 ;一例在发现眼肌麻痹后 ,经内科检查确诊为糖尿病。 1…     

Tolosa-Hunt综合征一例

Tolosa—Hunt综合征又称痛性眼肌麻痹，发病率较低，临床上少见，现将我院收治的1例报告如下。     

痛性眼肌麻痹综合征23例临床分析

痛性眼肌麻痹综合征是一组由头痛或眼眶周围痛伴颅神经（Ⅲ、Ⅳ、Ⅵ）损害的以眼球运动神经麻痹为主的临床综合征。１临床资料与方法收集的２３例患者中男１６例，女７例。年龄１６～５８岁，其中４０岁以上者１５例（占６５．２％）。急性起病１７例（７３．９％），慢性...     

T-cell lymphoma presenting as painful ophthalmoplegia

PURPOSE: To present a case of peripheral T-cell lymphoma presenting as painful ophthalmoplegia. METHODS: A 61-year-old woman presented with a 2-week history of headache and eyeball pain. Examination showed mild exophthalmos, complete ophthalmoplegia, and ptosis of the left eye. Under the impression of nonspecific orbital inflammation, she was treated with oral prednisone with initial response. Two months later, she revisited the clinic with exacerbated symptoms. Anterior orbitotomy and incisional biopsy was performed for the inferior rectus muscle lesion. RESULTS: Histopathologic examination revealed an infiltrate of atypical lymphoid cells between degenerative muscle bundles. It was consistent with peripheral T-cell lymphoma. A metastatic workup was performed without any evidence of extraorbital tumor. The patient was recommended to be treated with chemotherapy, however, refused to take the treatment. The patient died of progression of the disease in a month. CONCLUSIONS: T-cell lymphoma in the orbit can present as painful ophthalmoplegia and take a rapid clinical course. The disease should be regarded as one of the differential diagnosis for painful ophthalmoplegia refractory to corticosteroid therapy.     

疼痛性眼肌麻痹的临床特征及治疗

目的 探讨疼痛性眼肌麻痹的临床特征和治疗效果。方法 综合国内外文献和本文１０例病人的临床表现,应用皮质类固醇药物治疗。结果 随访３月至６年。９例４８ｈ～７２ｈ治愈,１例遗留视神经萎缩。４例复发２次１例复发３次,复发间隔时间数月至数年。结论疼痛性眼肌麻痹应以眼球后持续性疼痛并向前额和颞部放射;第３脑神经或合并第４、６脑神经麻痹及第５脑神经１、２支麻痹;角膜和前额部皮肤知觉异常;皮质类固醇药物治疗效果明显作为诊断依据。     

Vogt-Koyanagi-Harada syndrome in children

INTRODUCTION: Uveitis in children accounts for 5% to 10% of all uveitis cases. Some causes such as Vogt-Koyanagi-Harada syndrome rarely affect young children. We report two cases. CASE REPORT: No.1: A 9-year-old girl was followed up for severe and chronic total uveitis. General fundus depigmentation with several white and yellowish rounded lesions in peripheral fundus suggested the diagnosis of Vogt-Koyanagi-Harada, which was confirmed by the development of areas of vitiligo in the lumbar region. The patient was treated with a bolus of corticosteroid therapy. No. 2: A 12-year-old girl had bilateral uveopapillitis and the clinical initial examination and laboratory evaluation failed to provide a diagnosis. The patient was also treated with a bolus of corticosteroid therapy and then high-dose oral prednisone. After several months, the patient's examination showed a sunset glow fundus with several white and yellowish rounded lesions in peripheral fundus. DISCUSSION: Vogt-Koyanagi-Harada syndrome rarely affects young children, so the diagnosis may be difficult if the extraocular manifestations are not present. The bolus of corticosteroid therapy and cytotoxic agents may be necessary and the prognosis may be poor in severe cases.     

The Tolosa-Hunt syndrome: computed tomographic changes and reversal after steroid therapy

Painful ophthalmoplegia, or Tolosa-Hunt syndrome, is due to nonspecific inflammation of the cavernous sinus. We report two cases of the Tolosa-Hunt syndrome, which, on high resolution fourth-generation CT scan, showed an abnormality in the cavernous sinus consisting of an enhancing soft tissue mass. Both the clinical findings and the CT lesion resolved after high-dosage corticosteroid therapy.     

Orbital actinomycosis associated with painful ophthalmoplegia. Actinomycosis of the orbit

PURPOSE: To evaluate a case of orbital actinomycosis presenting as Tolosa-Hunt syndrome in a patient with a history of carcinomas of the kidney and breast. METHODS: A woman with ingravescent painful ophthalmoplegia was brought to our observation. Brain and orbital and total body CT scans showed the presence of two orbital neoformations and a miliary pattern of dissemination in the lung. The initial diagnosis, which pointed to secondary localisations of the previous kidney and breast tumours, was changed to orbital and pulmonary actinomycosis following microbiological analysis of lung biopsy samples. RESULTS: Prolonged antibiotic therapy with synthetic penicillin completely resolved the case. CONCLUSIONS: Actinomycosis is a very rare infection that may also affect the orbit and its association with a pulmonary dissemination is highly unusual. It is important to consider this type of infection among the causes of painful ophthalmoplegia.     

Steroid-responsive optic neuropathy in a patient with Tolosa-Hunt syndrome: Electrophysiologic findings

We examined visual evoked potentials and pattern electroretinograms in a patient with Tolosa-Hunt syndrome associated with optic nerve involvement. The 82-year-old woman developed unilateral painful ophthalmoplegia and visual loss in the right eye. Magnetic resonance imaging showed an abnormal soft-tissue area in the right cavernous sinus and the right orbital apex. Symptoms responded rapidly to treatment with corticosteroid. Visual evoked potentials to flash and pattern stimuli were both remarkably reduced and delayed in the right eye in the acute stage; however they improved to almost normal after steroid therapy. The pattern electroretinogram recorded in the acute stage was normal bilaterally. These results indicate that optic nerve involvement in Tolosa-Hunt syndrome can be mild and reversible.