The clinical analysis of recurrent Tolosa-Hunt syndrome / 中国医师进修杂志

Objective To analyze the clinical features, recurrent characters in patients with recurrent Tolosa-Hunt syndrome (THS). Methods The clinical data of 24 hospitalized patients with recurrent THS from January 2006 to May 2016 were collected The general features, clinical manifestations, disease courses, recurrent features, lab and imaging studies, treatment measures and outcoming of recurrent THS patients was investigated , and compared with 69 patients with first attack THS in corresponding period. Results Recurrent THS patients were 25.8%(24/93) of total THS. The male rate in recurrent group was significantly higher than that in first attack group: 66.7%(16/24) vs. 42.0%(29/69), P<0.05. The involved rate of trigeminal nerves in recurrent group was significantly lower than that in first attack group:16.7%(4/24) vs. 33.0%(23/69), P<0.05. The disease courses were from 3 months to 20 years. The total recurrent frequencies were from 2 to 10 times. The recurrence occurred in the same side in 18 patients, and in contralateral in other 6 patients. The intervals were from 3 months to 6 years, and average intervals were 1.9 years. Two patients recurred in hormone reduction, and 22 patients recurred in hormone withdrawal. All cases received MRI examination. Nineteen patients (79.2%) of them had lesions in cavernous sinus. 16 patients had one side lesions and 3 patients had bilateral lesions. The recurrent patients still had good responds to corticosteroids treatment. Conclusions Recurrences in THS are common, taking place in about 26%total patients, and usually at an interval of months or years from the initial attack. These recurrences may be ipsilateral, contralateral, or rarely, bilateral. Corticosteroids are still effective to recurrent cases.

Apoplejía tumoral pituitaria / Pituitary tumor apoplexy

La apoplejía tumoral pituitaria es un síndrome infrecuente que resulta del infarto y/o hemorragia espontánea de un adenoma pituitario preexistente. Ya que el evento primario involucra el adenoma, este síndrome debe ser nombrado como apoplejía tumoral pituitaria y no como apoplejía pituitaria. El aumento súbito en la presión de los contenidos de la silla turca da como resultado una cefalea de inicio agudo (puede ser incluso una "cefalea en trueno") de intensidad severa, alteraciones visuales y compromiso en la función pituitaria. El diagnóstico se basa en una alta sospecha clínica, imagen por resonancia magnética y medición de hormonas hipofisiarias en sangre. El tratamiento se basa en medidas de soporte (líquidos intravenosos y corticoides) y en casos sin buena respuesta o con deterioro neurológico, descompresión de silla turca. A continuación presentamos el caso de un adenoma previamente no diagnosticado que debutó como apolejía tumoral pituitaria. (Acta Med Colomb 2015; 40: 249-253).

Pituitary tumor apoplexy is an infrequent condition resulting from infarction and/or spontaneous bleeding from a pre-existing pituitary adenoma. This entity requires the prior existence of an adenoma in order to be named as pituitary tumor apoplexy, otherwise, it should be named pituitary apoplexy. The sudden increase in pressure of the sella turcica's contents results in a clinical syndrome characterized by headache (which can be "thunderclap headache"), visual disturbances and hypopituitarism. Diagnosis is not always straight forward and requires high clinical suspicion in addition to magnetic resonance imaging and measurement of serum pituitary hormones. Treatment is mainly based on supportive measures (intravenous fluids and steroids) and surgical decompression in those cases with no response to medical treatment and progressive neurological impairment. We report the case of a patient with a previously unknown pituitary adenoma presenting as a tumor apoplexy. (Acta Med Colomb 2015; 40: 249-253).

Síndrome de Tolosa-hunt: reporte de caso y revisión de la literatura / Tolosa-Hunt Syndrome: Case Report And Literature Review

El Síndrome de Tolosa-Hunt es una patología poco frecuente, definida como una inflamación granulomatosa idiopática del seno cavernoso o de la fisura orbitaria superior, caracterizado clínicamente por oftalmoplejía unilateral dolorosa, de evolución aguda o subaguda, asociada a anormalidades en la resonancia magnética de cerebro como el aumento en el volumen y la hipercaptación del medio de contraste del seno cavernoso comprometido. A continuación presentamos el caso de un paciente masculino de 23 años de edad quien consultó al Hospital Universitario del Valle por oftalmoplejía dolorosa de su ojo izquierdo, y en quien se concluyó la existencia de un Síndrome de Tolosa Hunt después de la realización estudios diagnósticos diferenciales exhaustivos.

The Tolosa-Hunt syndrome is an uncommon disease, described as an idiopathic granulomatous inflammation of the cavernous sinus or the superior orbital fissure. Its diagnosis is based on the presence of unilateral ophtalmoplegia associated with the enlargement and the enhanced contrast of the affected cavernus sinus in the MRI. We present the case of a 23-year-old man with ophthalmoplegia of the left eye, who was admitted to the Hospital Universitario del Valle. After performing extensive diagnostic studies, the Tolosa-Hunt syndrome was considered the cause of symptoms.

Parálisis criptogénica del III par craneal / Cryptogenic palsy of the third cranial nerve

La parálisis aislada del tercer par craneal no es frecuente en los niños. Entre las causas que la originan se encuentran las congénitas, traumáticas, infecciosas, tumorales, vasculares, tóxicas y desmielinizantes. Se presenta un paciente de 3 años de edad con el diagnóstico de una oftalmoplejía aguda dolorosa del tercer par craneal, cuya etiología no se pudo demostrar. El cuadro clínico desapareció de forma espontánea y no ha presentado recurrencias después de 3 años de seguimiento. Se concluye que ante un paciente con parálisis del tercer par craneal es necesario realizar una exhaustiva evaluación con el propósito de precisar las diversas causas que la provocan

Isolated third cranial nerve palsy is not frequent in children. Among the causes are congenital, traumatic, infectious, tumoral, vascular, toxic and demyelinizing. This is the case of a 3-years old patient diagnosed with acute painful ophthalmoplegia of the third cranial nerve, in which etiology could not be proved. The clinical picture disappeared spontaneously and no recurrence has emerged after 3 years of follow-up. It was concluded that when dealing with a patient with third cranial nerve palsy, it is necessary to make a thorough assessment to precise over the different causes

Oftalmoplejia dolorosa, un desafío diagnóstico: a propósito de un caso clínico de Tolosa-Hunt / Painful ophthalmoplegia, a diagnostic challenge: on a case of Tolosa-Hunt's syndrome

El clínico frente a una oftalmoplejia dolorosa, debe encarar diferentes alternativas diagnósticas, donde la disciplina semiológica y los estudios imagenológicos, son de capital importancia para arribar al diagnóstico. El síndrome de Tolosa-Hunt es una probable etiología, donde el uso de critérios diagnósticos, el estudio por resonancia magnética y la remisión con tratamiento corticoideo, son fundamentales para llegar al mismo, sabiendo que el seguimento evolutivo es de suma importancia para descartar los diagnósticos diferenciales.

Numb Chin Syndrome with Concomitant Painful Ophthalmoplegia Leading to a Diagnosis of Diffuse Large B Cell Lymphoma / Journal of the Korean Cancer Association, 대한암학회지

Painful ophthalmoplegia (PO) and concomitant numb chin syndrome (NCS) is a very rare event. There are a few reports in the literature about PO and concomitant NCS that have preceded the diagnosis of a malignancy. In this report, we describe a patient with diffuse large B cell lymphoma who presented with PO and concomitant NCS as the initial symptom of the disease.

Clinical Observations on Tolosa-Hunt Syndrome

PURPOSE: The authors reviewed clinical features, response to treatment and recurrence rate of Tolosa-Hunt syndrome. METHODS: A retrospective chart review was performed on 6 patients, who fulfilled the diagnosis for Tolosa-Hunt syndrome according to the International Headache Society (IHS) classification of 2004. RESULTS: Every patient had orbital pain as a first symptom, followed by cranial nerve paresis. The third cranial nerve was most commonly involved (83.3%), followed by the sixth nerve (50%), the forth nerve (16.7%), and the first branch of the fifth cranial nerve (16.7%). Two of the patients showed multiple cranial nerve paresis (33.3%, 2 out of 6). All patients received high-dose steroid therapy for more than 5 days, and all patients had resolution of orbital pain within 72 hours of treatment. Full recovery of cranial nerve paresis occurred on average in 2.3 months (3 days to 12 months). During the 29 months of follow-up, 2 patients (33.3%) had a recurrence episode. CONCLUSIONS: Tolosa-Hunt syndrome responds well to steroid therapy, and full recovery is possible with proper treatment. The exact diagnosis and treatment of Tolosa-Hunt syndrome is important. Because Tolosa-Hunt syndrome often recurs after full recovery, the authors suggest a minimum follow-up period of 2 years.

A case of Tolosa-Hunt syndrome / 소아과

Tolosa-Hunt syndrome is a rare disease in children characterized by dull, persistent pain around the affected eye and ophthalmoplegia caused by granulomatous inflammation in the cavernous sinus, superior orbital fissure, or orbit. Although spontaneous remission can occur, corticosteroids frequently have a dramatic response; however, recurrence can transpire after complete remission. We report an 11-year-old girl with Tolosa-Hunt syndrome who responded to corticosteroid promptly, without complications, but suffered three recurrences of headache and retro-orbital pain and required maintenance on a low dose of steroid.

Painful ophthalmoplegia secondary to nasopharyngeal carcinoma: a case report

A case of painful ophthalmoplegia with unilateral ocular pain, fixed eyeball to all directions of gaze, and loss of vision is presented. After intensive steroid therapy, conjunctival chemosis subsided markedly, but no improvement was seen in other clinical signs. We took a CT scan of orbit brain and performed nasopharyngeal biopsy and open biopsy through craniectomy. Based on the results of clinical features and findings of the CT scan and tissues, we diagnosed painful ophthalmoplegia secondary to nasopharyngeal carcinoma metastasized to orbital apex and brain.