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。     

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.     

Tolosa-Hunt综合征研究现状

Ｔｏｌｏｓａ－Ｈｕｎｔ综合征又称痛性眼肌麻痹综合征（ｐａｉｎｆｕｌｏｐｈｔｈａｌｍｏｐｌｅｇｉａｓｙｎｄｒｏｍｅ）。１９５４年Ｔｏｌｏｓａ［１］首先报告１例具有剧烈眼眶周围疼痛,同时眼球运动神经（Ⅲ、Ⅳ、Ⅵ）麻痹及角膜反射减弱患者。脑血管造影显示颈内...     

Tolosa—Hunt综合征1例

Tolosa -Hunt综合征又称痛性眼肌麻痹 ,临床罕见 ,我们发现 1例 ,报告如下。患者　李×　女　 45岁　主因双眼酸痛不适 2 0天 ,于2 0 0 3年 4月 5日就诊。患者 2 0天来 ,自觉双眼酸痛不适 ,不敢睁眼 ,曾点消炎眼水 ,口服消炎药物 (药名不详 ) ,无明显好转。两眼视力均为 4 8,双眼上睑结膜轻度充血 ,浅层结膜结石 ,并有沙眼滤泡 ,角膜清 ,前房中深 ,瞳孔正大 ,光反射好 ,眼底视盘边清 ,色正常 ,血管走行正常 ,黄斑区中心反射可见。诊断 :双眼沙眼、双眼结膜浅层结石。处理 :在表麻下行双眼结膜结石取出 ,术后氧氟沙星眼水冲洗 ,口服先锋霉素…     

Tolosa-Hunt综合征1例

资料患者男性,48岁,农民,彝族。因视物成双伴左眼疼痛、左前额疼痛2个月,于2009年3月26日入院。追问病史,视物成双与左眼疼痛基本同时出现,以眼眶痛为主,疼痛呈持续性钝痛,否认恶心、呕吐、发热等。患者曾在当地诊所口服药治疗(具体诊治情况不详),症状无明显变化。既往体健,无高     

Tolosa-Hunt综合征1例

1　临床资料患者 ,男 ,4 6岁 ,0 .5a前无明显诱因出现左侧剧烈偏头痛 ,痛欲撞墙 ,3月前出现左眼痛伴视力下降、复视及面部麻木 ,1月前眼睑肿胀伴眼球前突 ,低头咳嗽及睡眠时无加重 ,无视物变形、色觉异常 ,眼科检查 :右眼 ( ) ;左眼 :远近视力无光感 ,光定位正 ,红绿色觉可辩     

痛性眼肌麻痹综合征5例临床分析

目的 :探讨痛性眼肌麻痹综合征 (TolosaHuntSyn drome)的临床特点。方法 :对 5例痛性眼肌麻痹综合征患者的临床资料进行分析。结果 :5例痛性眼肌麻痹综合征患者均符合诊断标准 ,对激素治疗效果佳 ,4例痊愈 ,1例并发化脓性脑膜炎。结论 :痛性眼肌麻痹病因多样 ,临床表现复杂 ,诊断时应慎重。头颅CT、MRI及动脉造影对其诊断有一定的价值。大部分患者对激素疗效好 ,但需警惕炎症播散     

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。     

单眼痛性眼肌麻痹2例

例1女46岁因头痛、恶心、呕吐2天于2003年6月16日就诊于荆门市钟样某镇卫生院，当地以感冒诊治输用青霉素、病毒唑，6天后治疗无效，疼痛加剧伴随左眼险不能上抬．遂于2003年6月24日就诊于我院门诊眼科。检查：体温36．7℃，神志清，痛苦貌，颈软，生理反射正常，病理反射未引出。头部针扎样剧烈疼痛，伴眶周、牙龈根部及耳前     

Tolosa—Hunt综合征二例

ＴｏｌｏｓａＨｕｎｔ综合征二例牛建军苏玉民例１女性，６４岁。左眼、左前额及鼻梁左侧疼痛１０ｄ，加重伴复视、上睑下垂５ｄ。患者１０ｄ前无明显诱因出现左眼、左前额及鼻梁左侧持续性撕裂样剧痛，在他院按鼻炎治疗无效。５ｄ后症状加重，并出现复视、上睑下垂，来...     

Metastatic B-cell lymphoma of the cecum masquerading as Tolosa-Hunt syndrome

CASE REPORT: Imaging studies of a 41-year-old man who had developed a painful unilateral ophthalmoplegia showed a mass involving the right cavernous sinus region. The systemic workup disclosed a B-cell lymphoma in the cecum. COMMENTS: We report a case of metastatic cecum lymphoma masquerading as Tolosa-Hunt syndrome.     

The Tolosa-Hunt syndrome

Painful ophthalmoplegia due to idiopathic granulomatous inflammation of the cavernous sinus/superior orbital fissure has been termed Tolosa-Hunt syndrome (THS). This report is based upon 146 patients with this syndrome published in the English literature. The clinical profile, natural history, diagnostic evaluation, pathologic findings, differential diagnosis, and therapy of THS are presented. Careful initial patient examination and scrupulous follow-up evaluation are essential, as THS is categorically a diagnosis of exclusion. While the etiology of THS is unknown, current pathogenetic theories are reviewed.     

Pachymeningitis,Painful Ophthalmoplegia,and Multiple Cranial Neuropathy of Presumed Tuberculous Origin

The authors describe a patient with persistent headache initially diagnosed as idiopathic hypertrophic pachymeningitis after a comprehensive study that included meningeal biopsy. Despite early response to corticosteroids, the headache relapsed 3 years later and he further developed painful ophthalmoplegia and multiple cranial neuropathies (V1, VI, VIII, and X). A cervical lymph node biopsy revealed caseating granulomas and antituberculous therapy was started. Symptoms had resolved at 3-month follow-up. The authors discuss tuberculosis as a possible cause of pachymeningitis, painful ophthalmoplegia, and multiple cranial neuropathy syndromes, and describe the common features of these clinical conditions.     

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.     

Esthesioneuroblastoma Presenting with Complete External Ophthalmoplegia

An 85-year-old male presented with unilateral third, fourth, and sixth cranial nerve palsies. Neuroimaging revealed a mass involving the medial wall of the left cavernous sinus, without orbital involvement. Biopsy of the mass provided a pathologic diagnosis of esthesioneuroblastoma.     

Síndrome de oftalmoplejía dolorosa,más allá del síndrome de Tolosa Hunt. Una serie de casos

Painful ophthalmoplejía syndrome is characterised by the presence of peri-orbital or peri-cranial pain that is accompanied by paralysis of the oculomotor nerves. The differential diagnosis is broad, and requires a rigorous study. Three clinical cases of patients with painful ophthalmoplejía syndrome are described, in which multiple extension studies were required to obtain an aetiological diagnosis. Painful ophthalmoplejía syndrome is a complex disorder that has multiple causes, including infections, inflammatory, and tumour processes. Biopsy should be considered in those cases in which non-invasive studies are inconclusive.     

The Bell's Toll

A 70-year-old man presented complaining of lid and facial drooping and facial numbness, which progressed over several months. Magnetic resonance imaging of the head showed an enlarged right cavernous sinus. His past medical history was remarkable to squamous cell carcinoma of the face. The patient underwent a craniotomy with biopsy of the cavernous sinus that confirmed malignancy. High index of suspicion in a patient that presents facial drooping and/or numbness should alert ophthalmologists about the occurrence of perineural spread of a previous malignant lesion of the skin.     

The Tolosa-Hunt syndrome

The signs and symptoms of the Tolosa-Hunt syndrome are described and the results of orbital phlebography discussed. Emphasis is placed on the importance of systemic administration of corticosteroids, both as a diagnostic test and as a therapeutic measure.A case history is presented.     

Delayed ophthalmoplegia following head trauma

An eleven-year-old boy presented to the emergency room following frontal head trauma with injury to the right optic nerve. Two weeks later he developed progressive right ophthalmoplegia. The patient's ophthalmoplegia resolved following an operation. The differential diagnosis of this entity is discussed in detail.