Painful intraorbital meningiomas

Facial pain: Overlapping syndromes

Premise This review summarises the pain syndromes that overlap between headache and facial pain and overlap between pain and cranial nerve lesion. Problem These syndromes share two features in common. First, they show both cranial nerve impairment (e.g. palsy, autonomic dysfunction) and pain; second, they have inflammatory (and/or small vessel) processes as the underlying mechanism. A typical representative of these syndromes is recurrent painful ophthalmoplegic neuropathy, which was previously called ophthalmoplegic migraine and was regarded as a migraine subtype. It is now supposed that this syndrome is caused by an inflammation of one of the ocular motor nerves. Other syndromes discussed in this review are optic neuritis, Tolosa-Hunt syndrome, ischaemic ocular motor nerve palsy, and the very rare Raeder's syndrome. Treatment of all these syndromes is mainly based on steroids. Potential solution Management of possibly underlying disorders such as multiple sclerosis or atherosclerosis should also be considered.

An approach to the patient with painful ophthalmoplegia, with a focus on Tolosa-Hunt syndrome

The differential diagnosis of painful ophthalmoplegia is extensive and consists of numerous sinister etiologies, including neoplasms (ie, primary intracranial tumors, local or distant metastases), vascular (eg, aneurysm, carotid dissection, and carotid-cavernous fistula), inflammatory (ie, orbital pseudotumor, giant cell arteritis, sarcoidosis, and Tolosa-Hunt syndrome), and infectious etiologies (ie, fungal and mycobacterial), as well as other miscellaneous conditions (ie, ophthalmoplegic migraine and microvascular infarcts secondary to diabetes). A systematic approach to the evaluation of painful ophthalmoplegia can lead to prompt recognition of serious disorders that can be associated with significant morbidity or mortality if left untreated. Inflammatory conditions such as Tolosa-Hunt syndrome and orbital pseudotumor are highly responsive to corticosteroids but should be diagnoses of exclusion.

Clinical Without Histopathological Manifestations of Inflammation in a Patient With Primary Intraorbital Optic Nerve Sheath Meningioma

A 28-year-old man with a biopsy-proven benign intraorbital optic nerve sheath meningioma developed recurrent clinical manifestations of ipsilateral retrobulbar inflammation 9 years after undergoing postoperative radiation therapy. Debulking of the tumor 11 years after the original surgery again revealed no pathologic signs of inflammation. Whether growth of tumor, surgery, radiation, or edema triggered the inflammatory manifestations is unclear. Our case affirms that primary optic nerve meningiomas may rarely cause episodic manifestations resembling those of idiopathic orbital inflammation that resolve with corticosteroid treatment.

Painful ophthalmoplegia: Overview with a focus on tolosa-hunt syndrome

Painful ophthalmoplegia is an important presenting complaint to emergency departments, ophthalmologists, and neurologists. The etiological differential diagnosis of painful ophthalmoplegia is extensive and consists of numerous sinister etiologies including vascular (eg, aneurysm, carotid dissection, carotid-cavernous fistula), neoplasms (eg, primary intracranial tumors, local or distant metastases), inflammatory conditions (eg, orbital pseudotumor, sarcoidosis, Tolosa-Hunt syndrome), infectious etiologies (eg, fungal, mycobacterial), and other conditions (eg, microvascular infarcts secondary to diabetes, ophthalmoplegic migraine, giant cell arteritis). A systematic approach to the evaluation of painful ophthalmoplegia can lead to prompt recognition of serious disorders that if left untreated, can be associated with significant morbidity or mortality. Inflammatory conditions such as Tolosa-Hunt syndrome and orbital pseudotumor are highly responsive to corticosteroids, but should be diagnoses of exclusion.

Painful and painless ophthalmoplegia with cavernous sinus pseudotumour

Acquired isolated ophthalmoplegia in childhood has many potential causes. Although other ophthalmological or clinical features may aid lesion localisation, the absence of these does not preclude structural pathology. Two cases of cavernous sinus pseudotumour presented as ophthalmoplegia with and without pain. Magnetic resonance imaging of the cavernous sinus revealed the presence of enhancing tissue consistent in appearance with pseudotumour in both cases, and they responded well to steroid treatment. These cases emphasise the importance of detailed imaging of the cavernous sinus in the investigation of these symptoms in order to exclude this treatable condition.

Meningioma--an unusual forehead swelling: a case report

Meningiomas are rarely encountered by head and neck clinicians. This report describes a patient with a meningioma presenting uncommonly as a long-standing forehead mass with minimal symptoms. Investigation identified a large bifrontal meningioma with extra-cranial extension involving the right orbit and forehead. The literature is reviewed with particular reference to extra-cranial meningioma and the case is discussed.