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Park SH, Jang SI, Lee EJ, Kim NH. Case report: Tolosa-Hunt syndrome-expanding the neuromyelitis optica spectrum disorder phenotype? Front Neurol 2024; 15:1326867. [PMID: 38419701 PMCID: PMC10899484 DOI: 10.3389/fneur.2024.1326867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy caused by the autoantibody of aquaporin-4 (AQP4). Herein, we report a case of Tolosa-Hunt syndrome presenting with abducens palsy and AQP4 antibodies. This was a rare case of AQP4-immunoglobulin G seropositivity in a patient with Tolosa-Hunt syndrome. Our findings may expand the clinical phenotype of NMOSD and indicate that clinicians should consider testing for AQP4 antibodies in patients with Tolosa-Hunt syndrome.
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Affiliation(s)
- Soo-Hyun Park
- Department of Neurology, Soon Chunhyang University Hospital, Seoul, Republic of Korea
| | - Soo-Im Jang
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Eun-Ja Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Nam-Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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Kim HJ, Lee SU, Lee ES, Choi JY, Kim JS. Recurrence and long-term outcomes of Tolosa-Hunt syndrome. J Neurol 2024; 271:935-943. [PMID: 37853245 DOI: 10.1007/s00415-023-12044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND PURPOSE Tolosa-Hunt Syndrome (THS) is a rare disorder, and detailed clinical information and treatment outcomes have yet to be fully elucidated. This study aims to investigate the clinical features and factors associated with the treatment outcomes of THS, as defined by the established diagnostic criteria. METHODS This study retrospectively recruited 91 patients with a diagnosis of THS from 2003 to 2020. We analyzed the clinical features and outcomes, the initial treatment response, recurrences, and the final treatment response. RESULTS Isolated ocular motor nerve palsy was the most common (82.4%) finding of ophthalmoplegia, involving the oculomotor nerve in more than half of the cases (52.0%). The MRI lesions were mostly observed in the cavernous sinus (94.5%) with an extracavernous extension in about one-third of them. Five patients showed only extracavernous lesions. A total of 25 (27.5%) patients experienced recurrence. Recurrence occurred during steroid tapering as part of the initial treatment in seven, while in 18 patients, it happened after the successful termination of the initial treatment. However, all patients achieved complete remission at the final. Age was associated with a decrease in initial symptom duration (HR = 1.023, CI = 1.004-1.044) as well as an increase in recurrence-free duration (HR = 0.944, CI = 0.911-0.978). High-dose corticosteroid treatment was associated with a decrease in initial symptom duration (HR = 1.642, CI = 1.001-2.695) and total treatment duration (HR = 2.203 CI = 1.302-3.730). CONCLUSIONS THS can recur frequently especially in younger but have a favorable prognosis. High-dose corticosteroids can be an effective initial treatment and reduce the total treatment duration.
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Affiliation(s)
- Hyun-Jae Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sun-Uk Lee
- Neurotology Laboratory, Korea University Anam Hospital, Seoul, Republic of Korea
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Eek-Sung Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Tayebi A, Samimisedeh P, Jafari Afshar E, Mahmoudnia S, Milan N, Ayati A, Madady A, Rastad H. Neuromuscular diseases associated with COVID-19 vaccines: a systematic review and pooled analysis of 258 patients. BMC Neurol 2023; 23:437. [PMID: 38082244 PMCID: PMC10712145 DOI: 10.1186/s12883-023-03486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Neuromuscular diseases (NMD) emerged as one of the main side effects of the COVID-19 vaccination. We pooled and summarized the evidence on the clinical features and outcomes of NMD associated with COVID-19 vaccination. METHODS We comprehensively searched three databases, Medline, Embase, and Scopus, using the key terms covering "Neuromuscular disease" AND "COVID-19 vaccine", and pooled the individual patient data extracted from the included studies. RESULTS A total of 258 NMD cases following COVID-19 have been reported globally, of which 171 cases were Guillain-Barré syndrome (GBS), 40 Parsonage-Turner syndrome (PTS), 22 Myasthenia Gravis (MG), 19 facial nerve palsy (FNP), 5 single fiber neuropathy, and 1 Tolosa-Hunt syndrome. All (100%) SFN patients and 58% of FNP patients were female; in the remaining NMDs, patients were predominantly male, including MG (82%), GBS (63%), and PTS (62.5%). The median time from vaccine to symptom was less than 2 weeks in all groups. Symptoms mainly appeared following the first dose of vector vaccine, but there was no specific pattern for mRNA-based. CONCLUSION COVID-19 vaccines might induce some NMDs, mainly in adults. The age distribution and gender characteristics of affected patients may differ based on the NMD type. About two-thirds of the cases probably occur less than 2 weeks after vaccination.
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Affiliation(s)
- Amirhossein Tayebi
- Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Parham Samimisedeh
- Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Elmira Jafari Afshar
- Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Saeideh Mahmoudnia
- Department of Neurology, Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Nesa Milan
- Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Department of Orthopedics, Tehran university of medical sciences, Tehran, Iran
| | - Aryan Ayati
- Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Aryan Madady
- Department of Neurology, Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Hadith Rastad
- Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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Frattini D, Iodice A, Spagnoli C, Rizzi S, Cesaroni CA, Cappella M, Fusco C. Tolosa-Hunt syndrome and recurrent painful ophthalmoplegic neuropathy, case reports: what to do and when? Ital J Pediatr 2023; 49:157. [PMID: 38012680 PMCID: PMC10683099 DOI: 10.1186/s13052-023-01541-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/25/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Tolosa-Hunt syndrome (THS) and recurrent painful ophthalmoplegic neuropathy (RPON) are rare diseases reported within the "Painful lesions of the cranial nerves" section of the International Classification of Headache Disorders-3rd edition (ICHD-3). In case of a first painful attack, differential diagnosis could be challenging and many pitfalls are due to the rarity of the disorders and the lack of information about correct medical management in youngsters. CASE PRESENTATION Our main purpose was to report a new case of THS and a new case of RPON describing management and diagnostic investigation at the time of the first episode. In both cases of THS (13 years old) and RPON (14 years old) a unilateral periorbital headache associated with acute onset of ipsilateral third cranial nerve paresis, scarcely responding to non-steroidal anti-inflammatory drugs (NSAID), was present at the beginning of the first attack. Brain MRI with "time-of-flight" (TOF) angiography and the need to administer steroids (after 72 h from onset) in order to stop pain were the most important handles allowing us to adopt the correct management both in THS or RPON since onset and to face recurrences in RPON by avoiding useless therapy during follow-up. CONCLUSION Unilateral periorbital headache associated with third-fourth or sixth cranial nerve paresis should ideally be investigated with a full work-up, comprehensive of brain MRI with TOF angiography since the first attack. In cases with negative brain MRI spontaneous resolution should be considered and watchful waiting might be advisable before starting steroid therapy.
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Affiliation(s)
- Daniele Frattini
- Child Neurology Unit, Arcispedale Santa Maria Nuova Hospital - IRCCS, Viale Risorgimento 80, Reggio Emilia, 42123, Italy.
| | - Alessandro Iodice
- Child Neuropsychiatry Unit, S. Chiara Hospital, APSS, Largo Medaglie d'oro 9, Trento, 38122, Italy
| | - Carlotta Spagnoli
- Child Neurology Unit, Arcispedale Santa Maria Nuova Hospital - IRCCS, Viale Risorgimento 80, Reggio Emilia, 42123, Italy
| | - Susanna Rizzi
- Child Neurology Unit, Arcispedale Santa Maria Nuova Hospital - IRCCS, Viale Risorgimento 80, Reggio Emilia, 42123, Italy
| | - Carlo Alberto Cesaroni
- Child Neurology Unit, Arcispedale Santa Maria Nuova Hospital - IRCCS, Viale Risorgimento 80, Reggio Emilia, 42123, Italy
| | - Michela Cappella
- Pediatric Unit, Arcispedale Santa Maria Nuova Hospital - IRCCS, Viale Risorgimento 80, Arcispedale Santa Maria Nuova, Reggio Emilia, 42123, Italy
| | - Carlo Fusco
- Child Neurology Unit, Arcispedale Santa Maria Nuova Hospital - IRCCS, Viale Risorgimento 80, Reggio Emilia, 42123, Italy
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Sasi S, Nair AP, Kolleri J, Alzibdeh A, Maslamani MSRA. Disseminated tuberculosis masquerading as Tolosa-Hunt syndrome in initial presentation: A case report with literature review. Radiol Case Rep 2023; 18:1353-7. [PMID: 36712191 DOI: 10.1016/j.radcr.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/07/2023] [Indexed: 01/22/2023] Open
Abstract
Tolosa-Hunt syndrome (THS) is a painful ophthalmoplegia due to non-specific granulomatous inflammation in the cavernous sinus region. It is diagnosed by the International Classification of Headache Disorders (ICHD)-3 criteria. We report the case of a young lady who presented with a right-sided headache for 2 weeks, followed by right-sided diplopia for 4 days. Clinical examination revealed right trochlear nerve palsy. Magnetic resonance imaging (MRI) of her brain showed abnormal thickening and postcontrast enhancement of the right orbital apex and superior orbital fissure, suggesting THS. Examination of cerebrospinal fluid (CSF) ruled out intracranial infection. The initial presentation satisfied the ICHD-3 criteria. Further imaging revealed cervical, axillary, and intra-abdominal lymphadenopathy with granulomatous lesions in the spleen and right kidney. Ultrasound (US)-guided axillary lymph node biopsy was positive for Mycobacterium tuberculosis. QuantiFERON TB gold plus test from serum was positive. Based on radiological and histopathological findings, a diagnosis of disseminated tuberculosis involving lymph nodes, kidneys, spleen, and lungs was made. THS is a diagnosis of exclusion. This case signifies that patients diagnosed with THS based on ICHD-3 criteria should be extensively evaluated to rule out granulomatous infections such as tuberculosis. Typical THS symptoms with granulomatous inflammation can give false reassurance to clinicians and prevent investigation for more dangerous etiologies. As painful ophthalmoplegia can arise secondary to a myriad of pathologies, diagnostic workups for all possibilities should be exhausted before arriving at a diagnosis of THS. Regardless of MRI findings, workups for tuberculosis and fungal infections should be completed.
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Rodríguez SS, Gómez-Muga JJ, Onandi RR, Gallarreta ZD, García-Moncó JC. A 57-year-old man with painful ophthalmoplegia and cavernous sinus involvement: Why this is not Tolosa-Hunt syndrome. Eur J Neurol 2022; 29:3127-3129. [PMID: 36073199 DOI: 10.1111/ene.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022]
Abstract
Tolosa-Hunt syndrome (THS) is an idiopathic condition included in the differential diagnosis of painful ophthalmoplegia. Although this was once a common diagnosis, the increasing availability of tests reveals an alternative etiology in many cases. Exclusion of treatable disorders is important, because the prognosis may otherwise be poor. We here describe a patient who presented with painful ophthalmoplegia with an infiltrating lesion in the cavernous sinus. Initially suspected of THS, he had a fatal evolution, and postmortem evaluation revealed cervicocephalic actinomycosis. Actinomycosis diagnosis is often missed, and still represents a challenge to the clinician. We highlight pearls and pitfalls to establish a proper diagnosis to avoid missing a treatable condition in patients with suspected THS.
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Affiliation(s)
- Saúl Silvarrey Rodríguez
- Department of Neurology, Osakidetza Basque Health Service, Basurto University Hospital, Bilbao, Spain
| | - Juan José Gómez-Muga
- Department of Radiology, Osakidetza Basque Health Service, Basurto University Hospital, Bilbao, Spain
| | - Rebeca Ruiz Onandi
- Department of Pathology and Bio-Bank, Txagorritxu University Hospital, Vitoria, Spain
| | - Zuriñe Diez Gallarreta
- Department of Hematology, Osakidetza Basque Health Service, Basurto University Hospital, Bilbao, Spain
| | - Juan Carlos García-Moncó
- Department of Neurology, Osakidetza Basque Health Service, Basurto University Hospital, Bilbao, Spain
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Kishimoto S, Morita S, Kurimoto C, Kitahara C, Tsuji T, Uraki S, Takeshima K, Furukawa Y, Iwakura H, Furuta H, Nishi M, Matsuoka TA. Hypopituitarism and cranial nerve involvement mimicking Tolosa-Hunt syndrome as the initially presenting feature of diffuse large B-cell lymphoma: a case report. BMC Endocr Disord 2022; 22:65. [PMID: 35287660 PMCID: PMC8919580 DOI: 10.1186/s12902-022-00973-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/24/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Early diagnosis of lymphoma involving the central nervous system is sometimes difficult but emergent to avoid the delay of therapeutic initiation. Pituitary insufficiencies are usually associated with lymphoma in the pituitary gland. There have been no cases of lymphoma originating from extra pituitary gland with hypopituitarism that simultaneously presenting unilateral upper cranial nerve palsies and ophthalmalgia. These symptoms are mostly caused by neoplastic involvement of the skull base or benign diseases such as Tolosa-Hunt syndrome (THS). We report a case of lymphoma with unique clinical courses initially presenting hypopituitarism and symptoms mimicking THS with a mass in sphenoidal and cavernous sinuses accompanying sphenoidal bone erosion. CASE PRESENTATION A 71-year-old woman visited our hospital with left ophthalmalgia, ptosis, and diplopia. Neurological findings revealed left oculomotor, trochlear and abducent nerve palsies. Endocrine tests indicated partial hypopituitarism. Initial CT and MRI revealed that a mass in sphenoidal and cavernous sinuses had invaded the sella with osteolysis of the sphenoid bone. At around four weeks, almost all the symptoms of cranial nerve palsies were relieved. Seven weeks later, she had a high fever and cervical lymph node (CLN) swellings. CLN biopsy revealed CD20-positive B-cells. She was diagnosed with diffuse large B-cell lymphoma (DLBCL). 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) revealed elevated uptake at the erosion lesion of the sphenoidal bone, but not the pituitary gland. After chemotherapy, all the symptoms related to systemic lymphoma were relieved, but partial hypopituitarism remained. The mass in sphenoidal and cavernous sinuses and elevated uptake by PET/CT were dissolved. CONCLUSION This case of DLBCL had a unique clinical course; initial presentation of hypopituitarism and symptoms mimicking THS. There was also rare demonstration of mass lesions related to DLBCL in the sphenoidal and cavernous sinuses compressing the pituitary gland through an eroded area of the sphenoidal bone. It should be clinically cautioned that DLBCL can be associated with erosion of the sphenoidal bone and cause both hypopituitarism and THS-mimicking symptoms.
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Affiliation(s)
- Shohei Kishimoto
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shuhei Morita
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan.
| | - Chiaki Kurimoto
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Chie Kitahara
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tomoya Tsuji
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shinsuke Uraki
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ken Takeshima
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasushi Furukawa
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwakura
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroto Furuta
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Nishi
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Taka-Aki Matsuoka
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan
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Arenas Díaz RD, Calderón Castro ADP. Painful ophthalmoplegia syndrome, beyond Tolosa-Hunt syndrome. A case series. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:677-681. [PMID: 34844691 DOI: 10.1016/j.oftale.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/26/2020] [Indexed: 06/13/2023]
Abstract
Painful ophthalmoplegia 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 ophthalmoplegia syndrome are described, in which multiple extension studies were required to obtain an aetiological diagnosis. Painful ophthalmoplegia 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.
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Affiliation(s)
- R D Arenas Díaz
- Servicio de Neurología Clínica, Universidad Nacional de Colombia, Bogotá, Colombia; Grupo de investigación en Neurología de la Universidad Nacional de Colombia, NEUOUNAL, Bogotá, Colombia.
| | - A de P Calderón Castro
- Servicio de Neurología Clínica, Universidad Nacional de Colombia, Bogotá, Colombia; Grupo de investigación en Neurología de la Universidad Nacional de Colombia, NEUOUNAL, Bogotá, Colombia
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Emori K, Matsuno R, Omachi T, Yamanouchi S, Kaneko K. The youngest Japanese case of Tolosa-Hunt syndrome. Pediatr Int 2021; 63:1129-1131. [PMID: 34176188 DOI: 10.1111/ped.14573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Kohei Emori
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | - Ryosuke Matsuno
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | - Taichi Omachi
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | | | - Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
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Abstract
Background The objective of this study was to investigate the clinical features and outcomes of Tolosa-Hunt syndrome (THS). Methods A retrospective review of the medical records was performed on patients with THS between March 2016 and January 2020. A total of eleven patients fulfilling the International Classification of Headache Disorders (ICHD-3 beta) diagnostic criteria for THS were included in this study. Results The average age of the patients with THS was 57.18 ± 15.32 years and the mean duration of recovery was 26.91 ± 24.35 days. All eleven patients had orbital or periorbital pain as the first symptom followed by diplopia. Ptosis was found in five patients (45.45 %) in the involved eye. Sixth cranial nerve (CN) palsy was most common (eight cases, 72.73 %), followed by third and fourth CN palsy (five cases, 45.45 %, respectively), optic neuritis (two cases, 18.18 %), and trigeminal nerve and facial nerve palsy (one case, 9.09 %, respectively). One patient with optic neuritis failed to recover visual acuity and the other ten patients completely recovered their ocular motor limitation. All patients were initially treated with steroids. One patient relapsed after five weeks and one patient had a history of THS five years earlier. Conclusions THS responded well to steroid treatment, but if it was accompanied by optic neuritis as optic nerve involvement, we suggest follow-up with high dose steroid treatment especially was important.
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Affiliation(s)
- Hyuna Kim
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Shin Yeop Oh
- Department of Ophthalmology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, 51353, Changwon, Korea.
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Abstract
Tolosa-Hunt syndrome is an uncommon disease that exhibits unilateral periorbital pain or headache, accompanied by cranial nerve palsies. Myasthenia gravis is an acquired immune system disease involving the neuromuscular junction. One rare case of Tolosa-Hunt syndrome combined with ocular myasthenia gravis had been reported in the literature, but not general myasthenia gravis. We present a patient with a probable coincidence of Tolosa-Hunt syndrome and general myasthenia gravis. A 63-year-old male exhibited episodes of unilateral headache with double vision, bilateral ptosis, vision decrease in the left eye and left facial hypoesthesia, muscle weakness in limbs and neck. The muscle weakness was fluctuating and could be relieved by rest. Blood analysis, cranial magnetic resonance imaging, magnetic resonance angiography/venogram) and orbit/mediastinum computed tomography demonstrated no abnormalities. Serum myasthenia gravis related antibodies detection showed positive titin- antibodies and ryanodine receptor antibodies. Corticosteroid and pyridostigmine bromide treatments were effective. Each of the patient's symptoms had almost disappeared at the third-month follow-up. We speculate on the etiology of Tolosa-Hunt syndrome with general myasthenia.
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Affiliation(s)
- Lu Li
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116000, P. R. China
| | - Zhe Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116000, P. R. China
| | - Ming-Ou Lu
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116000, P. R. China
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Zhang N, Shao C, Pan Y, Xiong G, Wang J, Liu Z, Chen B. Multiple Spontaneous Visceral Arterial Dissections in a Patient With Tolosa-Hunt Syndrome on Corticosteroid Therapy. Ann Vasc Surg 2021; 74:523.e1-523.e7. [PMID: 33838239 DOI: 10.1016/j.avsg.2021.01.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/17/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
Multiple spontaneous visceral arterial dissections are an infrequent occurrence. The etiology, risk factors and natural history of these dissections have not been elucidated, and the optimal therapeutic strategy has not been established. We report a rare case of multiple spontaneous visceral arterial dissections involving the celiac artery, splenic artery, superior mesenteric artery, and right renal artery in a patient with Tolosa-Hunt syndrome on short-term corticosteroid therapy. The patient was subjected to conservative treatment and endovascular repair, achieving good clinical and radiological outcomes during the long-term follow-up period.
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Affiliation(s)
- Naiding Zhang
- Department of Vascular Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Changming Shao
- Department of Vascular Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yifeng Pan
- Department of Vascular Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guiya Xiong
- Department of Science and Research, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jian Wang
- Department of Vascular Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhenjie Liu
- Department of Vascular Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Bing Chen
- Department of Vascular Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Durmaz GS, Ak AK, Gökçay F, Çelebisoy N. Trigeminal neuralgia following Tolosa-Hunt syndrome. Acta Neurol Belg 2021. [PMID: 33826103 DOI: 10.1007/s13760-021-01659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
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Lee KP, Sung PS, Lee WJA. Tolosa-Hunt syndrome as initial presentation of Systemic Lupus Erythematosus. Acta Neurol Taiwan 2021; 30(1):39-42. [PMID: 34549400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Case presentation of newly diagnosed systemic lupus erythematosus (SLE) presenting initially as Tolosa-Hunt syndrome (THS). STUDY DESIGN Retrospective clinical case. METHOD Case report. RESULTS A healthy young man developed acute binocular diplopia within 2 days without other neurological deficits. Bilateral 6th cranial nerve palsy was observed with general reduction in the visual field test. Emergent brain magnetic resonance image (MRI) was performed, which revealed severe inflammation in the cavernous sinus, superior orbital fissure, and apex of the orbit. No cavernous thrombosis or intracranial lesion was shown in the MRI. THS was diagnosed and the patient's CN 6 palsy recovered quickly after corticosteroid treatment. However, severe anaemia was discovered during admission (Hb=6.0), so the patient was evaluated by profound laboratory tests, which revealed SLE. CONCLUSION With painful ophthalmoplegia, cavernous sinus syndrome is highly suspected. THS is one of the differential diagnoses for cavernous sinus syndrome. THS is a rare disease, recognized by the National Organization for Rare Disorders, and characterized by inflammatory changes in the cavernous sinus, superior orbital fissure and/or orbital apex under image study. The inflammatory changes are mostly idiopathic, but secondary causes such as sarcoidosis or other autoimmune diseases need to be ruled out. Physicians should be aware of possible underlying conditions, such as immunosuppressed status as in SLE, as the true cause of THS.
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Affiliation(s)
- Kang-Po Lee
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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15
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Arenas Díaz RD, Calderón Castro ADP. Painful ophthalmoplegia syndrome, beyond Tolosa-Hunt syndrome. A case series. Arch Soc Esp Oftalmol (Engl Ed) 2020; 96:S0365-6691(20)30436-6. [PMID: 33384172 DOI: 10.1016/j.oftal.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- R D Arenas Díaz
- Servicio de Neurología Clínica, Universidad Nacional de Colombia, Bogotá, Colombia; Grupo de investigación en Neurología de la Universidad Nacional de Colombia, NEUROUNAL, Bogotá, Colombia.
| | - A de P Calderón Castro
- Servicio de Neurología Clínica, Universidad Nacional de Colombia, Bogotá, Colombia; Grupo de investigación en Neurología de la Universidad Nacional de Colombia, NEUROUNAL, Bogotá, Colombia
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16
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Park B, Raviskanthan S, Mortensen P, Lee AG, Bilyk JR. Escaping from the hunt. Surv Ophthalmol 2021; 66:1065-9. [PMID: 33129799 DOI: 10.1016/j.survophthal.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/21/2020] [Indexed: 11/21/2022]
Abstract
A 69-year-old woman presented with chronic, painful, progressive binocular diplopia. Examination showed deficits in multiple sequential cranial nerves (II, III, IV, V1,2,3, and VI). She was initially diagnosed with Tolosa-Hunt syndrome and had a partial response to systemic corticosteroids. Skull base biopsy eventually showed poorly differentiated carcinoma consistent with perineural spread of squamous cell carcinoma.
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17
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Abstract
The article reviews the main ocular features of Herpes Zoster Ophthalmicus (HZO) including Ramsay-Hunt and Tolosa-Hunt syndromes that involve III, IV and VI pairs of cranial nerves and I branch of the trigeminal nerve, and describes treatment methods of its active manifestations and postherpetic neuralgia, as well as herpes zoster vaccination practices.
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Affiliation(s)
| | | | - O I Pimonova
- Research Institute of Eye Diseases, Moscow, Russia
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18
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Kim HJ, Lee S, Koo YJ, Kwon E, Kim HJ, Choi JY, Kim JS. Tacrolimus for Treating Orbital and Cranial Form of Idiopathic Inflammatory Pseudotumors. J Clin Neurol 2020; 16:674-680. [PMID: 33029975 PMCID: PMC7541994 DOI: 10.3988/jcn.2020.16.4.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Orbital and cranial form of idiopathic inflammatory pseudotumors (IIPs) are rare disorders with heterogeneous clinical presentations. Corticosteroids have been the first-line treatment for IIPs, but they are not always effective. Methods We reviewed the medical records of three patients with orbital or cranial form of IIP who were treated with tacrolimus as an adjuvant treatment. Results The three patients showed favorable outcomes with the addition of tacrolimus, which is a calcineurin inhibitor that inhibits T-cell activation and T-cell-dependent B-cell activation. Conclusions Tacrolimus may be a safe and effective immunosuppressant for refractory or relapsing form of orbital or cranial IIPs.
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Affiliation(s)
- Hyun Jae Kim
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Medical Sciences, Neurology, Graduate School of Ajou University, Suwon, Korea
| | - Seonkyung Lee
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yu Jin Koo
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunjin Kwon
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Ji Soo Kim
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
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19
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Munawar K, Nayak G, Fatterpekar GM, Sen C, Zagzag D, Zan E, Hagiwara M. Cavernous sinus lesions. Clin Imaging 2020; 68:71-89. [PMID: 32574933 DOI: 10.1016/j.clinimag.2020.06.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022]
Abstract
The cavernous sinus is a complex structure susceptible to a wide variety of vascular, neoplastic and inflammatory pathologies. Vascular pathologies include ICA aneurysms, carotid-cavernous fistulas, cavernous sinus thrombosis, and cavernous hemangioma. Neoplasms that involve the cavernous sinus include pituitary adenoma, meningioma, schwannoma, lymphoma, perineural tumor spread, metastases, and direct tumor invasion. Infectious and inflammatory diseases include Tolosa-Hunt syndrome, sarcoidosis, granulomatosis with polyangiitis, IgG-4 related disease and invasive fungal infections. In this article, we review the clinical and imaging findings of a number of pathologies involving the cavernous sinus, focusing on key features that can narrow the differential diagnosis and, in some cases, support a particular diagnosis.
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Affiliation(s)
- Kamran Munawar
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Gopi Nayak
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Girish M Fatterpekar
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Chandra Sen
- NYU Langone Health, Department of Neurosurgery, New York, NY, United States of America
| | - David Zagzag
- NYU Langone Health, Department of Pathology, New York, NY, United States of America
| | - Elcin Zan
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Mari Hagiwara
- NYU Langone Health, Department of Radiology, New York, NY, United States of America.
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20
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Douedi S, Awad M, Shenouda D, Mack P, Carson MP. Tolosa-Hunt Syndrome: A Non-Classical Presentation of a Rare Cause of Unilateral Headache and Painful Ophthalmoplegia. J Clin Med Res 2020; 12:266-268. [PMID: 32362975 PMCID: PMC7188369 DOI: 10.14740/jocmr4123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/11/2020] [Indexed: 11/11/2022] Open
Abstract
Tolosa-Hunt syndrome is a rare condition involving the orbital and retro-orbital space. The typical symptoms are orbital pain, swelling, headache, palsies of the cranial nerves, and sensory loss in the distribution of the trigeminal nerve. Tolosa-Hunt syndrome relapses and remits with episodes separated by months to years. It is a diagnosis of exclusion after ruling out other causes of painful ophthalmoplegia and is treated with high-dose steroids. We present a case of a 43-year-old woman with a history of recurrent headaches and vision disturbances for the past 4 years presenting with worsening left-eye pain that radiated to the back of her head, swelling around the left eye, double vision, and a unilateral left-sided headache. Visual acuity was decreased in the left eye compared to the right and the patient reported left-eye pain when at extreme medial and lateral gaze. Erythrocyte sedimentation rate (ESR) was found to be elevated with all other laboratory testing within normal limits. Computed tomography (CT) scan of the orbits was unremarkable. Ophthalmology excluded other differential diagnoses and she was treated with intravenous methylprednisolone with significant improvement of symptoms. The triad of one or more episodes of unilateral orbital pain, paresis of one or more of the cranial nerves, and granulomas by magnetic resonance imaging (MRI) or biopsy is 95-100% sensitive at diagnosing the syndrome; however, our patient did not present with the "classic" triad. Initial treatment of Tolosa-Hunt is with high-dose steroids which as in our case lead to rapid and significant improvement of symptoms.
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Affiliation(s)
- Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Mark Awad
- St. George University School of Medicine, St George, Grenada
| | - Daniel Shenouda
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Prinze Mack
- Department of Ophthalmology, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Michael P Carson
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
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21
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Abstract
The occurrence of Tolosa-Hunt syndrome (THS) in the setting of discoid lupus erythematosus (DLE) has not been previously reported. We report a case of a 55-year-old Chinese man with established cutaneous lupus who presented with 1 week of worsening blurry vision and ptosis of the left eye with severe headache 2 weeks prior to presentation. His cranial nerve examination was significant for left afferent pupillary defect, red desaturation, ptosis, and oculomotor nerve palsy. He also presented with active DLE lesions. Magnetic resonance imaging brain demonstrated asymmetric thickening and enhancement of the left cavernous sinus consistent with THS. After a 4-week gradual steroid taper his ophthalmoplegia resolved. The unusual occurrence of THS and DLE prompts consideration of nonsystemic autoimmune disorders in diagnosis of THS.
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Affiliation(s)
- Amy W Yu
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Eli J Finkelsztein
- Department of Internal Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Natalie T Cheng
- Department of Neurosciences, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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22
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Tsirigotaki M, Ntoulios G, Lioumpas M, Voutoufianakis S, Vorgia P. Tolosa-Hunt Syndrome: Clinical Manifestations in Children. Pediatr Neurol 2019; 99:60-3. [PMID: 30982655 DOI: 10.1016/j.pediatrneurol.2019.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tolosa-Hunt syndrome (THS) is a rare condition in children characterized by painful ophthalmoplegia caused by inflammation of unknown etiology in the cavernous sinus, superior orbital fissure, or orbital apex. Our main purpose was to report two pediatric cases of THS, a typical one and another extremely rare one preceded by facial palsy. METHODS Both cases were diagnosed with THS based on the 2013 International Classification of Headache Disorders (ICHD-3 beta) criteria. A literature review was also performed concerning epidemiology, clinical and imaging features, diagnostic criteria, treatment, and outcome of THS with a focus on children. RESULTS The first patient was a 14-year-old boy who presented with third nerve palsy, four weeks after the diagnosis and treatment of peripheral seventh nerve palsy and the second patient was a 10-year-old girl who presented with a five-day history left-sided ptosis, periorbital pain, and diplopia. CONCLUSIONS THS is a rare condition in pediatric population that requires an extensive evaluation before the final diagnosis is made. Seventh nerve palsy preceding the diagnosis of THS is particularly rare in children. This patient represents only the second reported example of seventh nerve involvement in a child with THS.
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23
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Abstract
Tolosa-Hunt syndrome is characterized by a painful ophthalmoplegia secondary to a granulomatous inflammation in or adjacent to the cavernous sinus. Magnetic resonance imaging will show enhancement of the cavernous sinus and/or the orbital apex. Although this syndrome is extremely rare in children, it should be a diagnostic consideration in patients presenting with painful ophthalmoplegia with variable involvement of cranial nerves II to VI. The differential diagnosis for unilateral cavernous sinus lesion is broad, including vascular lesions (cavernous sinus thrombosis), inflammatory processes (sarcoidosis, autoimmune), neoplastic processes (schwannoma, lymphoma), as well as infectious etiologies. We describe a pediatric patient presenting with neurological symptoms from a unilateral cavernous sinus magnetic resonance imaging abnormality and the thorough diagnostic approach to arrive at the diagnosis of Tolosa-Hunt syndrome.
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Affiliation(s)
| | | | - Samrat U Das
- 1 Duke University School of Medicine, Durham, NC, USA
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24
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Harris GR, Breazzano MP, Shyu I, Donahue SP, Lavin PJM. Oculomotor Synkinesis (Aberrant Reinnervation of the Third Cranial Nerve) Associated with Atypical Tolosa-Hunt Syndrome. Neuroophthalmology 2019; 44:262-266. [PMID: 33012913 DOI: 10.1080/01658107.2019.1576738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A 70-year-old woman with systemic lupus erythematosus developed a painful pupil-involving right third nerve palsy, ipsilateral fourth nerve palsy, and periorbital paraesthesia. Magnetic resonance imaging demonstrated enhancement and thickening of the right third nerve, and she was diagnosed with presumed Tolosa-Hunt syndrome. Repeated imaging seven months later showed resolution of the enhancing thickened oculomotor nerve, but the patient developed signs of oculomotor synkinesis. This presentation demonstrates a rare case of oculomotor synkinesis secondary to inflammation.
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Affiliation(s)
- Glenn R Harris
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark P Breazzano
- Department of Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Irene Shyu
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sean P Donahue
- Department of Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patrick J M Lavin
- Department of Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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25
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Abstract
We herein report a patient with Miller Fisher syndrome mimicking Tolosa-Hunt syndrome. A 47-year-old man presented with right orbital pain and diplopia. On a neurological examination, he had right oculomotor nerve palsy and diminished deep tendon reflexes. Brain magnetic resonance imaging failed to show any parenchymal lesions; however, the bilateral oculomotor nerves were gadolinium-enhanced. The presence of a triad of orbital pain, ipsilateral oculomotor nerve palsy, and a rapid response to steroid therapy met the diagnostic criteria for Tolosa-Hunt syndrome. After discharge, antibodies against GQ1b and GT1a were reported to be positive only with phosphatidic acid. The present case was ultimately diagnosed as an incomplete phenotype of Miller Fisher syndrome.
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Affiliation(s)
- Masahiro Oomura
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yuto Uchida
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Keita Sakurai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Takanari Toyoda
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Kenji Okita
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Noriyuki Matsukawa
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Japan
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26
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Ishikawa R, Ishikawa Y, Kubota T, Shirahama K. A case of delirium in Tolosa-Hunt syndrome during corticosteroid therapy. JA Clin Rep 2018; 4:58. [PMID: 32026006 DOI: 10.1186/s40981-018-0193-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Corticosteroid therapy is useful for the resolution of pain and paresis in Tolosa-Hunt syndrome; however, there is no definitive protocol for appropriate dosing, route of administration, or duration of therapy. Steroid psychosis is an adverse reaction to corticosteroid therapy; in severe cases, it can develop into psychiatric disorders such as delirium, depression, and mania. In this case study, we report a patient with Tolosa-Hunt syndrome who developed delirium while receiving corticosteroid therapy. CASE PRESENTATION The patient was a 70-year-old man being treated for a main complaint of pain in the right eye accompanied by oculomotor paralysis. We suspected Tolosa-Hunt syndrome based on diagnostic imaging and other findings. Steroid pulse therapy was initiated with intravenous methylprednisolone at 1000 mg/day for 3 days, followed by oral prednisolone at 60 mg/day. The pain in the right eye disappeared the day after starting this regimen, and palpebral ptosis also improved. However, 5 days after starting treatment, the patient developed progressively worsening delirium, which was considered an adverse reaction to the steroid pulse therapy. Then, prednisolone treatment was temporarily suspended, and the delirium subsequently disappeared. CONCLUSIONS The manifestation of steroid psychosis following corticosteroid therapy is dose dependent. Therefore, corticosteroid therapy for elderly patients requires caution and dose modulation because of likely adverse drug reactions.
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27
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Ruff MW, Carabenciov ID, Johnson DR, Pollock BE, Parisi JE, Klaas JP. A cavernous sinus lesion clinically responsive to steroids. J Clin Neurosci 2018; 53:239-240. [PMID: 29685413 DOI: 10.1016/j.jocn.2018.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/09/2018] [Indexed: 11/27/2022]
Abstract
Tolosa Hunt syndrome (THS) is characterized by painful ophthalmoplegia secondary to idiopathic granulomatous inflammation of the cavernous sinus. The characteristic finding on MRI is an enhancing T1 isointense and T2 hypo- or hyperintense cavernous sinus mass lesion, which may result in focal narrowing of the ipsilateral internal carotid artery. Although the incidence is quite rare, it is a common diagnostic consideration in cases that present with multiple cranial neuropathies. However, the differential diagnosis for a unilateral cavernous sinus lesion in adults is broad and includes neoplastic, inflammatory (such as sarcoidosis and immunoglobulin G4-related disease [IgG4-RD]), infectious etiologies (such as syphilis and leprosy), as well as vascular lesions. We describe a patient presenting with neurologic symptoms referable to a persistent unilateral cavernous sinus MRI abnormality, initially thought to be consistent with Tolosa-Hunt syndrome, that was clinically but not radiographically responsive to steroids. Following reevaluation due to the presence of new symptoms, pathology revealed that the abnormality was most consistent with chordoma, a rare skull based tumor. In patients with a presumed diagnosis of Tolosa-Hunt syndrome, close clinical and radiographic follow-up is imperative, with early consideration for biopsy in patients that fail to respond to treatment both clinically and radiographically.
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Affiliation(s)
- M W Ruff
- Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
| | | | - D R Johnson
- Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
| | - B E Pollock
- Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
| | - J E Parisi
- Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
| | - J P Klaas
- Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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28
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Affiliation(s)
- Asri Yuliati
- Department of Neurology, Children Hospital of Michigan, Detroit, MI, USA
| | - Kumar Rajamani
- Department of Neurology, Detroit Receiving Hospital, Detroit, MI, USA
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29
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Abstract
The authors report a rare case of bilateral Tolosa-Hunt syndrome, which occurred in a 80-year-old female and remitted spontaneously. Inflammatory lesions were found not only in typical locations, i.e. superior orbital fissures and cavernous sinuses, but also in the pituitary; these imitated gland's macroadenoma in imaging studies.
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Affiliation(s)
| | - Dominik Stodulski
- Department of Otolaryngology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Babińska
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Krzysztof Sworczak
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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30
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AKPINAR ÇK, ÖZBENLİ T, DOĞRU H, İNCESU L. Tolosa-Hunt Syndrome - Cranial Neuroimaging Findings. Noro Psikiyatr Ars 2017; 54:251-254. [PMID: 29033638 PMCID: PMC5630104 DOI: 10.5152/npa.2016.13791] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/02/2016] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The etiology of Tolosa-Hunt Syndrome (THS) is still unknown. The initial standard magnetic resonance imaging (MRI) may not be sufficient for diagnosis, so dynamic contrast-enhanced MRI may be necessary to demonstrate the presence of lesions. METHODS Seven patients diagnosed with THS according to the International Headache Society criteria (beta version) were included into the study. Patients were assessed in terms of type, age, symptoms and findings, accompanying disease, localization of the determined lesion, response to treatment, and clinical progress. The "Tolosa-Hunt protocol" was applied in all patients, and the cavernous sinuses, orbital apices, and orbits were evaluated. The parameters used for the patients were as follows: Turbospin echo T1 and T2 weighted sequences on the axial plane, turbospin echo fat-saturated T2 weighted sequence on the coronal plane, turbospin echo T2 weighted sequence on the sagittal plane, spin echo fat-saturated T1 sequences repeated on the axial and coronal planes followed by intravenous administration of gadolinium. In all sequences the slice thickness was 3 mm. RESULTS Four of seven cases diagnosed with THS were males, and the average age of the patients was 45.7±18.1 years (range 25-69 years). A follow-up MRI in patient 5 after three months showed decreased signal intensity and enhancement of the affected cavernous sinus. CONCLUSION Conventional MRI may be insufficient to show the granulomatous inflammation, and an MRI method referred to as the Tolosa-Hunt protocol should be applied to those who are thought to have THS.
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Affiliation(s)
| | - Taner ÖZBENLİ
- Department of Neurology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Hakan DOĞRU
- Department of Neurology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Lütfi İNCESU
- Department of Radiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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31
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Abstract
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.
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Affiliation(s)
- Stefan Evers
- 1 Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany.,2 Faculty of Medicine, University of Münster, Germany
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32
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Litwin CE, Leung ASO. Tolosa-Hunt syndrome presenting during pregnancy following progesterone administration. Int J Gynaecol Obstet 2017; 137:340-341. [PMID: 28295285 DOI: 10.1002/ijgo.12145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 11/29/2016] [Accepted: 03/07/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Charles E Litwin
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Annie S O Leung
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
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Murtaza G, Konowitz N, Lu H, Faqah A, Kuruvilla A. An Interesting Case of Tolosa-Hunt Syndrome in a Young Male. J Investig Med High Impact Case Rep 2017; 5:2324709616689478. [PMID: 28210639 PMCID: PMC5298529 DOI: 10.1177/2324709616689478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/11/2016] [Accepted: 12/26/2016] [Indexed: 11/24/2022] Open
Abstract
Tolosa-Hunt syndrome is a rare disease with a limited number of cases reported in the literature. It typically presents with orbital pain associated with palsy of the third, fourth, or sixth cranial nerve. We present an interesting case of Tolosa-Hunt syndrome in a young male who responded well to high-dose steroids and in a few days had significant improvement in his retro-orbital pain and ocular movements.
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Affiliation(s)
| | - Nicholas Konowitz
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Hannah Lu
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Anadil Faqah
- UIC/Advocate Christ Medical Center, Oak Lawn, IL, USA
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Lee JM, Park JS, Koh EJ. Gamma Knife radiosurgery in steroid-intolerant Tolosa-Hunt syndrome: case report. Acta Neurochir (Wien) 2016; 158:143-5. [PMID: 26611689 DOI: 10.1007/s00701-015-2648-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/17/2015] [Indexed: 01/03/2023]
Abstract
Tolosa-Hunt syndrome is a rare cause of painful ophthalmoplegia due to idiopathic chronic granulomatous inflammation in the cavernous sinus. Usually clinical manifestations are well controlled by corticosteroid therapy, but steroid dependency or resistance is common. We report a case of marked improvement of Tolosa-Hunt syndrome without symptom relapse after Gamma Knife radiosurgery in a patient with steroid intolerance.
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Affiliation(s)
- Jong-Myong Lee
- Department of Neurosurgery, Research Institute of Clinical Medicine, Institute for Medical Science, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Jung-Soo Park
- Department of Neurosurgery, Research Institute of Clinical Medicine, Institute for Medical Science, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
- Department of Neurosurgery, Chonbuk National University Medical School/Hospital, Geumam-dong, Deokjin-gu, Jeonju, 561-712, Korea.
| | - Eun-Jeong Koh
- Department of Neurosurgery, Research Institute of Clinical Medicine, Institute for Medical Science, Chonbuk National University Medical School and Hospital, Jeonju, Korea
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Hung CH, Chang KH, Chen YL, Wu YM, Lai CL, Chang HS, Lyu RK, Wu YR, Chen CM, Huang CC, Chu CC, Chen CH, Ro LS. Clinical and radiological findings suggesting disorders other than tolosa-hunt syndrome among ophthalmoplegic patients: a retrospective analysis. Headache 2015; 55:252-64. [PMID: 25688645 DOI: 10.1111/head.12488] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate clinical and radiological features of Tolosa-Hunt syndrome (THS) and examine their diagnostic value, and to propose clinical and radiological features that indicate other symptomatic painful ophthalmoplegias (SPOs) in order to distinguish them from THS. BACKGROUND Clinical presentations of THS are nonspecific and may overlap with many etiologies. Therefore, excluding other SPOs is essential for correct diagnosis. At the present time, the predictive value of the current International Classification of Headache Disorders (ICHD) criteria is not well established, and specific imaging markers that can discriminate SPOs from THS are lacking. METHODS Patients referred with painful ophthalmoplegia over 12 years were recruited retrospectively and allocated into THS or SPO groups. Typical symptoms (episodic unilateral orbital pain preceding or developing with diplopia) and imaging of THS (inflammatory lesions in the cavernous sinus/orbit by magnetic resonance imaging) were proposed based on ICHD-3 beta criteria and previous literature. Atypical clinical and radiological features suggesting alternative diagnoses were also proposed to predict SPO. Initial presentations and imaging findings were registered and correlated with diagnostic outcomes. The predictive value of clinical and imaging findings was then evaluated. RESULTS Of the 61 referred cases, 25 were classified as THS and 36 as SPO. Of the SPO cases, 52.8% manifested typical THS symptoms at onset. Patients with SPOs were prone to have atypical symptoms (47.2%) and radiographical findings (82.1%) in comparison to those with THS (4.0% and 4.2%, respectively; both P < .001). Both typical symptoms and imaging findings predicted a diagnosis of THS with high sensitivity (95.8% and 100%, respectively) but low specificity (47.2% and 28.6%, respectively). High sensitivity (82.1%) and specificity (95.8%) were achieved using atypical imaging features to predict SPO. CONCLUSION A diagnosis of THS based strictly on clinical presentations or imaging results is not completely reliable. Identification of atypical imaging features may have a useful role in discriminating SPOs and thus avoid erroneous diagnoses of THS. Future studies with larger sample sizes are warranted to evaluate their validity in general population.
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Affiliation(s)
- Chih-Hsien Hung
- Department of Neurology, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Medical University Hospital; Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
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Abstract
BACKGROUND We are reporting a rare case of a 60-year-old woman with a past history of end-stage renal disease and non-Hodgkin lymphoma who presented to our hospital with confusion, unilateral headache, painful ophthalmoplegia and ptosis. The patient was diagnosed clinically with Tolosa-Hunt syndrome (THS). RESULTS THS is a diagnosis of exclusion. Other diseases were ruled out. Magnetic resonance imaging (MRI) of the brain and orbit was negative twice within a week. The patient was treated with corticosteroids with marked improvement of the orbital pain and headache and mild improvement of the cranial nerves palsy. CONCLUSION Clinical diagnosis of THS could be supported by radiological findings. According to the International Classification of Headache Disorders (ICHD)-3 beta diagnostic criteria, the diagnosis must be confirmed with an abnormal MRI and/or pathological sample. We add to the previous findings of THS with a normal MRI. Although MRI plays a crucial role in differential diagnosis, it should not, nor should the biopsy, be a must for the diagnosis. Limitations of using MRI in some patients are another problem.
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Affiliation(s)
| | - Daniel Orozco
- Department of Neurology, Conemaugh Memorial Medical Center, PA, USA
| | - William Fink
- Department of Medicine, Conemaugh Memorial Medical Center, PA, USA
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Rotstein DL, Tyndel FJ, Tang-Wai DF. A case report of cavernous sinus syndrome in a patient with Takayasu's arteritis. Headache 2014; 54:1371-5. [PMID: 24827146 DOI: 10.1111/head.12390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 11/26/2022]
Abstract
Neurologists must entertain a broad differential diagnosis when considering a patient with cavernous sinus syndrome, including neoplasm, trauma, vascular causes, inflammatory processes, and infections. We report the case of a 37-year-old woman initially diagnosed with cavernous sinus syndrome, where subsequent investigations revealed findings of Takayasu's arteritis, a large vessel vasculitis. The patient also tested positive for perinuclear antineutrophil cytoplasmic antibodies, suggesting the possibility of a vasculitic spectrum disorder although no clinical features of Wegener's granulomatosis were present. Criteria for Takayasu's arteritis and its protean neurologic manifestations are reviewed. This case highlights the spectrum of vasculitic conditions that may be associated with cavernous sinus inflammation.
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Affiliation(s)
- Dalia L Rotstein
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Zhang X, Zhou Z, Steiner TJ, Zhang W, Liu R, Dong Z, Wang X, Wang R, Yu S. Validation of ICHD-3 beta diagnostic criteria for 13.7 Tolosa-Hunt syndrome: Analysis of 77 cases of painful ophthalmoplegia. Cephalalgia 2014; 34:624-32. [PMID: 24477599 DOI: 10.1177/0333102413520082] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 11/28/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Three editions of International Classification of Headache Disorders (ICHD) diagnostic criteria for Tolosa-Hunt syndrome (THS) have been published in 1988, 2004 and 2013, in ICHD-3 beta, there have been considerable changes [corrected]. The validity of these new diagnostic criteria remains to be established. METHODS We retrospectively identified 77 patients with non-traumatic painful ophthalmoplegia (PO) admitted between 2003 and 2013. We reviewed patients' age at onset and gender, time courses between onset of pain and development of cranial nerve palsy, the cranial nerves involved, imaging findings, therapeutic efficacy of steroid treatment and recurrence of attacks. RESULTS THS was the most frequent type of PO (46/77). In THS patients, the third cranial nerve was most commonly involved (76.3%). The median time interval between pain and cranial nerve palsy was two days, although in five patients (10.9%) the interval ranged from 16 to 30 days. Definitely abnormal MRI findings were found in 24 patients (52.2%). CONCLUSIONS It is essential to rule out other causes of PO in diagnosing THS, with MRI playing a crucial role in differential diagnosis. It may be helpful to understand and master the entity of THS for researchers and clinicians to adjust the gradation and ranking of the diagnostic criteria.
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Affiliation(s)
- Xingwen Zhang
- Department of Neurology, Chinese PLA General Hospital, PR China
| | - Zhibing Zhou
- Department of Neurology, Chinese PLA General Hospital, PR China
| | - Timothy J Steiner
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
| | - Wei Zhang
- Department of Neurology, Chinese PLA General Hospital, PR China
| | - Ruozhuo Liu
- Department of Neurology, Chinese PLA General Hospital, PR China
| | - Zhao Dong
- Department of Neurology, Chinese PLA General Hospital, PR China
| | - Xiaolin Wang
- Department of Neurology, Chinese PLA General Hospital, PR China
| | - Rongfei Wang
- Department of Neurology, Chinese PLA General Hospital, PR China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, PR China
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Abstract
It has been known for over a century that these cranial nerves exist, and that they are not typographical errors nor a sensational event reported in the medical literature. A number of scientific articles on anatomy highlight how textbooks on descriptive anatomy do not always consider variables such as differences related to the geographical areas where people live, and these differences do exist. This is an important concept not only for surgeons, but also for all medical professionals who use manual techniques when treating their patients, ie, osteopaths, chiropractors, physiotherapists, and other manual therapists. This paper highlights the latest developments regarding these cranial nerves, offering at the same time some ideas for further reflection when looking at clinical scenarios that appear to bear little relationship to each other. Inclusion of these concepts in everyday anamnesis is encouraged.
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Affiliation(s)
- Bruno Bordoni
- Don Carlo Gnocchi IRCCS, Department of Cardiology, Milan
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Hung CH, Chang KH, Wu YM, Chen YL, Lyu RK, Chang HS, Wu YR, Chen CM, Huang CC, Chu CC, Liao MF, Wai YY, Hsu SP, Ro LS. A comparison of benign and inflammatory manifestations of Tolosa-Hunt syndrome. Cephalalgia 2013; 33:842-52. [PMID: 23475292 DOI: 10.1177/0333102412475238] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tolosa-Hunt syndrome (THS) manifests as a benign or an inflammatory type disease. The nosography differences between these types remain to be elucidated. We aimed to analyze and compare the clinical presentations of benign and inflammatory THS. METHODS The ward patients who presented with THS from January 1990 to May 2011 were retrospectively reviewed. THS was diagnosed according to the recommendations of the International Headache Society. RESULTS Of the 53 THS cases (49 patients), 30 (56.6%) were classified as benign and 23 (43.4%) as inflammatory THS. There were strong similarities between the groups in terms of clinical manifestations, laboratory findings, responses to glucocorticoid treatment, and outcomes. However, patients with inflammatory THS tended to be younger (mean age, 43.4 years; P 0.05) and have optic nerve dysfunction (56.5%; P 0.05) and longer disease duration (2.3 ± 1.0 months; P 0.05) compared to those with benign THS (mean age, 56.4 years; mean disease duration, 1.6 ± 0.7 months). The patients with additional involvement of both the optic nerve and the second division of the trigeminal nerve experienced a longer disease duration ( P 0.05). Additionally, patients with orbital pseudotumors had diplopia that responded poorly to treatment with glucocorticoids ( P 0.05). High-dose (>0.5 mg/kg/day) and low-dose (≤0.5 mg/kg/day) prednisolone were equally effective in relieving symptoms in both groups ( P > 0.05). CONCLUSION Benign and inflammatory THS were highly similar in terms of nosography. The responses to glucocorticoid treatment were generally good except in patients with orbital pseudotumors.
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Affiliation(s)
- Chih-Hsien Hung
- Department of Neurology, E-Da Hospital, I-Shou University, Taiwan
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