ABSTRACT
Trochleitis is an easily treatable condition; however, it is often misdiagnosed by many clinicians because of its rare incidence. We report the case of a 14-year-old Saudi male patient, known to have type 1 diabetes mellitus (DM) and pansinusitis, who presented to the emergency department with a one-day history of severe right periorbital pain exacerbated by upgaze and supraduction. There was intense point tenderness on palpation over the trochlear region of the orbit with no underlying swelling or redness. Both eyes had a corrected visual acuity of 0.8. Mildly limited elevation (-1) of the right eye was noted. All other extraocular movements were normal in both eyes. Contrast-enhanced CT of the head and orbits showed mild trochlear swelling, inflammation, and pansinusitis. He was treated with a single intratrochlear injection of steroids, which immediately and significantly improved the symptoms. To the best of our knowledge, this is the second case of trochleitis associated with paranasal sinusitis in children. This suggests that a possible, but rare, association between these two conditions may exist in the pediatric population.
ABSTRACT
Trochleitis is usually a transient and non-disabling inflammation of the trochlea of superior oblique. The case is presented of a difficult to manage bilateral trochleitis in a 29-year-old woman. After an exhaustive aetiological study with neuro-imaging tests, as well as an analysis of autoimmunity and infection, no underlying cause was found. Multiple injections of corticosteroids were required in both eyes, with a partial effect. Surgical intervention was finally decided in order to visually examine the trochlea, take biopsies, and inject methylprednisolone. These were effective in relieving the symptoms. This case is exceptional due to it involving both eyes and its severity, and represented a therapeutic challenge for the clinical team.
Subject(s)
Methylprednisolone , Oculomotor Muscles , Adult , Biopsy , Eye , Female , Humans , Methylprednisolone/therapeutic use , Oculomotor Muscles/pathologyABSTRACT
La trocleítis es habitualmente una inflamación transitoria, unilateral y no incapacitante de la tróclea del oblicuo superior. Presentamos el caso de una trocleítis bilateral en mujer de 29 años de evolución tórpida. Tras estudio etiológico exhaustivo con pruebas de neuroimagen, análisis de autoinmunidad e infeccioso no se encontró ninguna causa subyacente. Precisó múltiples infiltraciones en ambos ojos con efecto parcial. Finalmente se decidió intervención quirúrgica para exploración visual de la tróclea, toma de biopsias e infiltración de metilprednisolona que resultaron eficaces en el alivio sintomático. Este caso es excepcional por su bilateralidad y severidad, suponiendo un desafío terapéutico para el equipo clínico (AU)
Trochleitis is usually a transient and non-disabling inflammation of the trochlea of superior oblique. The case is presented of a difficult to manage bilateral trochleitis in a 29-year-old woman. After an exhaustive aetiological study with neuro-imaging tests, as well as an analysis of autoimmunity and infection, no underlying cause was found. Multiple injections of corticosteroids were required in both eyes, with a partial effect. Surgical intervention was finally decided in order to visually examine the trochlea, take biopsies, and inject methylprednisolone. These were effective in relieving the symptoms. This case is exceptional due to it involving both eyes and its severity, and represented a therapeutic challenge for the clinical team (AU)
Subject(s)
Humans , Female , Adult , Trochlear Nerve Diseases/diagnostic imaging , Trochlear Nerve Diseases/drug therapy , Oculomotor Muscles/physiopathology , Methylprednisolone/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Severity of Illness Index , Magnetic Resonance SpectroscopyABSTRACT
Trochleitis is usually a transient and non-disabling inflammation of the trochlea of superior oblique. The case is presented of a difficult to manage bilateral trochleitis in a 29-year-old woman. After an exhaustive aetiological study with neuro-imaging tests, as well as an analysis of autoimmunity and infection, no underlying cause was found. Multiple injections of corticosteroids were required in both eyes, with a partial effect. Surgical intervention was finally decided in order to visually examine the trochlea, take biopsies, and inject methylprednisolone. These were effective in relieving the symptoms. This case is exceptional due to it involving both eyes and its severity, and represented a therapeutic challenge for the clinical team.
ABSTRACT
Migraine and tension-type headaches (TTHs) comprise a significant burden of neurological disease globally. Trochleodynia, also known as primary trochlear headache or trochleitis, may go unrecognized and contribute to worsening of these headache disorders. It may also present in isolation. We review the English literature on this under-recognized condition and describe what is known about the theorized pathophysiology, clinical presentation, and differential diagnosis. We also present a management algorithm for patients presenting with trochleodynia.
