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.
Subject(s)
Tolosa-Hunt Syndrome/diagnosis , Adolescent , Anti-Inflammatory Agents/therapeutic use , Blepharoptosis/etiology , Cavernous Sinus/diagnostic imaging , Cavernous Sinus/pathology , Child , Diagnosis, Differential , Diplopia/etiology , Facial Paralysis/etiology , Female , Humans , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Neuroimaging , Oculomotor Nerve Diseases/etiology , Tolosa-Hunt Syndrome/complications , Tolosa-Hunt Syndrome/drug therapy , Tomography, X-Ray Computed , Vomiting/etiologyABSTRACT
Glucose metabolism of children with drug-resistant epilepsy, controlled by antiepileptic drugs epilepsy, and first-time nonfebrile seizures was studied through the performance of an oral glucose tolerance test and through insulin, C-peptide, and glycosylated hemoglobin measurements. In the refractory epilepsy group, there were more abnormal oral glucose tolerance test results (62.07%) in comparison to the controlled epilepsy group (25%) and the group of first-time seizures (21.21%). There was a significant difference between the group of refractory epilepsy and every other group concerning the abnormality of the oral glucose tolerance test (P < .05). The mean values of insulin, HbA1c, and C-peptide levels were normal for all groups. The results of the present study suggest that there is a distinction of refractory epilepsies from the drug-controlled ones and the first-induced seizures relating to their metabolic profile, regardless of the type of seizures.
