Orbital venography in painful ophthalmoplegia (Tolosa-Hunt syndrome).

Twenty-six patients with painful ophthalmoplegia were classified as having the Tolosa-Hunt syndrome on the basis of their clinical findings and response to steroid therapy. All patients underwent orbital venography, a review of which forms the contents of this investigation. Orbital venography, a review of which forms the contents of this investigation. Orbital venograms were normal in 16 patients and abnormal in 10. The major abnormalities were (1) obstruction of the superior ophthalmic vein in its third segment without displacement; (2) collateral venous flow through small venous channels or collateral veins; and (3) poor opacification of the ipsilateral cavernous sinus.     

Orbital phlebography in patients with Tolosa-Hunt's syndrome in comparison with normal subjects

Orbital phlebography has been reported to be pathologic in some patients with Tolosa-Hunt's syndrome (recurrent painful ophthalmoplegia). A systematic study of the phlebographic findings in Tolosa-Hunt's syndrome in comparison with a normal material seems not to have been performed. In this investigation, orbital phlebography was performed in 19 patients with Tolosa-Hunt's syndrome and in a reference group of 23 persons without the disease. In 13 of 19 patients (68%) with Tolosa-Hunt's syndrome, the phlebography was pathologic (narrowing or occlusion of particularly the third segment of the superior ophthalmic vein, partial occlusion of the cavernous sinus). Orbital phlebography was normal in all but one of the subjects in the reference group. The medical history of this subject in retrospect revealed symptoms other than painful ophthalmoplegia commonly found in patients with Tolosa-Hunt's syndrome, suggesting that he suffered from a variant of the disease causing the syndrome. In one patient with recurrent painful ophthalmoplegia a biopsy from an eye muscle showed venous vasculitis, probably indicating the basic pathology behind the phlebographic changes in patients with Tolosa-Hunt's syndrome.     

Orbital phlebography for differentiation between multiple sclerosis and venous vasculitis in subacute blindness

Thirteen consecutive patients with subacute unilateral loss of vision and periorbital pain but without pathology of the fundus or increased erythrocyte sedimentation rate, were investigated with visual evoked response, electrophoresis of serum and cerebrospinal fluid, and orbital phlebography. Seven of these patients were found to suffer from multiple sclerosis. The remaining 6 were considered to have venous vasculitis. There was a spontaneous recovery from visual impairment in all patients with multiple sclerosis, but not in patients with venous vasculitis. Of the latter patients, only two, who were treated with steroids within the first four days after onset of symptoms, regained vision. It appears that orbital phlebography is the diagnostic procedure of choice for proper management of patients with subacute loss of vision.     

Tolosa-Hunt syndrome: MR imaging features in 15 patients with 20 episodes of painful ophthalmoplegia

Purpose

(a) To assess MR features in patients with Tolosa-Hunt syndrome (THS) and to (b) correlate MR findings with criteria derived from previously reported pathologic observations.

Methods

Fifteen patients with twenty episodes of painful ophthalmoplegia prospectively selected according to International Headache Society (IHS) standards underwent MR examinations focused on the cavernous sinus. Initial examinations in 20 and follow-up MR images in 17 episodes were retrospectively reviewed by 3 independent observers.

Results

The primary criteria: an enhancing soft tissue lesion within the cavernous sinus, increase in size and lateral bulging of the anterior cavernous sinus contour were consistently present in 15 initial episodes and in 5 recurrences (20/20). Agreement among observers was 100%. The secondary criteria: internal carotid artery narrowing in 7 patients, extension towards the superior orbital fissure in 13 and orbital apex involvement in 8 patients were unanimously agreed upon in 87.5%, 86.6% and 80%. Complete resolution of findings was observed on follow-up studies.

Conclusion

In patients with THS the MR features conform to previously reported pathologic findings. MR features are evocative of THS when an increase in size and bulging of the dural contour of the anterior CS supplemented by carotid artery involvement and extension towards the orbit are present. Resolution of findings within 6 months is required to support the diagnosis.     

Orbital phlebography. IV. The carernous sinuses and adjacent venous sinuses of the skull base.

Frontal phlebography has been used to examine the cavernous sinuses and adjacent basal venous sinuses of the skull. The method has proved to be simple and effective. The normal phlebographic anatomy of the basal sinuses and their drainage has been revised in a material of 26 cases. A normal range for the transverse diameter of the pituitary fossa has been established.     

The potential of vertebral phlebography for the diagnosis of tumours in the posterior cranial fossa

Summary The diagnostic value of the vertebral phlebogram is emphasized. A practice orientated principle is recommended for the classification of infratentorial veins. A total of 132 phlebograms taken from patients with infratentorial tumours is analyzed for local diagnosis, general diagnosis, venous circulatory disorder, and pathological veins. An example is given to underline the importance of tomography in vertebral phlebography.

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Vertebralis-Phlebographie zum Nachweis von Tumoren im Bereich der hinteren Schädelgrube — Diagnostische Möglichkeiten

Zusammenfassung Der diagnostische Wert der Vertebralis-Phlebographie wird abgenhandelt anhand von 132 Patienten mit raumfordernden Prozessen im Bereich der hinteren Schädelgrube.

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Les veines de la fosse posterieure dans le diagnostic des masses expansives

Résumé Dans 132 cas de tumeurs sous-tentorielles, l'auteur analyse les éléments de diagnostic, les troubles circulatoires et les veines anormales. L'utilité de l'angio-tomographie est illustrée par 1 cas.

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Extract from Graduation-B dissertation, Humboldt-Universität zu Berlin     

Orbital varices: a tricky diagnosis in MRI

Orbital varix (OV) is a rare condition causing intermittent positional exophthalmos. Because of low venous pressure, OVs tend to collapse, being frequently undetectable in routine CT or MRI examinations. We describe one case of giant intraorbital varix studied with CT and MRI techniques. Correspondence to: L. Manfré     

Arterial phlebography of the leg

On conventional ascending phlebography of the leg the deep femoral and pelvic veins are poorly visualized or not visualized at all. These veins are presumed to be the site of thrombosis and a source of pulmonary embolism in many instances. Diagnostic images of deep femoral and pelvic veins were obtained in 4 patients using injection of 30 ml of iopromide 300 mg I/ml into the iliac artery and DSA imaging of the venous phase of the angiogram.