1
|
La Mantia L, Curone M, Rapoport AM, Bussone G. Tolosa–Hunt Syndrome: Critical Literature Review Based on IHS 2004 Criteria. Cephalalgia 2016; 26:772-81. [PMID: 16776691 DOI: 10.1111/j.1468-2982.2006.01115.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In 2004, the International Headache Society (IHS) re-defined the diagnostic criteria of Tolosa–Hunt syndrome (THS) specifying that granuloma, demonstrated by magnetic resonance imaging (MRI) or biopsy, is required for diagnosis. We reviewed the literature on THS published from 1988 (year of publication of first IHS criteria) to 2002, analysing individual cases in relation to the new IHS criteria. One hundred and twenty-four cases were identified. As far as it was possible to discern, clinical presentation was similar in all, but 44 (35±) were reported to have inflammation on MRI or bioptic evidence of granuloma, 41/124 (33±) had normal neuroimaging findings and 39 (31±) had a specific lesion, so the THS was secondary. These data confirm that clinical criteria for THS are common to several conditions and their application alone does not guarantee a correct diagnosis. The requirement for inflammation on MRI will result in better classification of painful ophthalmoplegias; nevertheless, an MRI protocol that best defines inflammation should be specified. The status of cases which fulfil the clinical criteria but have normal MRI remains to be clarified.
Collapse
Affiliation(s)
- L La Mantia
- Department of Clinical Neurology, Neurological Institute C Besta, Milan, Italy
| | | | | | | |
Collapse
|
2
|
Colnaghi S, Versino M, Marchioni E, Pichiecchio A, Bastianello S, Cosi V, Nappi G. ICHD-II Diagnostic Criteria for Tolosa—Hunt Syndrome in Idiopathic Inflammatory Syndromes of the Orbit and/or the Cavernous Sinus. Cephalalgia 2008; 28:577-84. [DOI: 10.1111/j.1468-2982.2008.01569.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A bibliographical search was conducted for papers published between 1999 and 2007 to verify the validity of International Classification of Headache Disorders (ICHD)-II criteria for the Tolosa-Hunt syndrome (THS) in terms of (i) the role of magnetic resonance imaging (MRI); (ii) which steroid treatment should be considered as adequate; and (iii) the response to treatment. Of 536 articles, 48, reporting on 62 patients, met the inclusion criteria. MRI was positive in 92.1% of the cases and it normalized after clinical resolution. There was no evidence of which steroid schedule should be considered as adequate; high-dose steroids are likely to be more effective both to induce resolution and to avoid recurrences. Pain subsided within the time limit required by the ICHD-II criteria, but signs did not. We conclude that THS diagnostic criteria can be improved on the basis of currently available data. MRI should play a pivotal role both to diagnose and to follow-up THS.
Collapse
Affiliation(s)
- S Colnaghi
- Department of Neurology, University of Pavia, Pavia
- Department of Neuro-Otology and Neuro-Ophthalmology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
- UCADH—University Centre for Adaptive Disorders and Headache, University of Pavia, Pavia
| | - M Versino
- Department of Neurology, University of Pavia, Pavia
- Department of Neuro-Otology and Neuro-Ophthalmology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
- UCADH—University Centre for Adaptive Disorders and Headache, University of Pavia, Pavia
| | - E Marchioni
- UCADH—University Centre for Adaptive Disorders and Headache, University of Pavia, Pavia
- Department of Clinical Neurology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
| | - A Pichiecchio
- Department of Neuroradiology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
| | - S Bastianello
- Department of Neurology, University of Pavia, Pavia
- Department of Neuroradiology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
| | - V Cosi
- Department of Neurology, University of Pavia, Pavia
- Department of Clinical Neurology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
| | - G Nappi
- UCADH—University Centre for Adaptive Disorders and Headache, University of Pavia, Pavia
- Scientific Direction, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
- Department of Neurology and ENT, University ‘La Sapienza’, Roma, Italy
| |
Collapse
|