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tolosa hunt syndrome

Carlos A Pérez, Monaliza Evangelista
BACKGROUND: Tolosa-Hunt syndrome is a painful ophthalmoplegia caused by an inflammatory process of unknown etiology in the region of the cavernous sinus, orbital apex, or superior orbital fissure. This disease is rare in the pediatric population. The objective of this study was to provide a clinical framework for the evaluation and treatment of children with this disorder. A systematic approach to the diagnosis of painful ophthalmoplegia in children is proposed. METHODS: We present a 15-year-old girl whose clinical presentation and neuroradiological findings support a diagnosis of Tolosa-Hunt syndrome as defined by the 2013 International Classification of Headache Disorders (Third Edition, ICHD-3 beta) diagnostic criteria...
September 2016: Pediatric Neurology
Amol Raheja, Aleksandra Sowder, Cheryl Palmer, Fausto J Rodriguez, William T Couldwell
Epstein-Barr virus (EBV)-associated smooth muscle tumors (SMTs) have recently been associated with primary and secondary immunodeficiencies. They are broadly divided into 3 subgroups: HIV-related, posttransplant, and congenital immunodeficiency. Subsequent to organ transplantation and acquired immunosuppression, a few cases of EBV-associated SMTs have been described in the liver, respiratory tract, and gastrointestinal system. To the authors' knowledge, intracranial involvement after peripheral blood stem cell transplantation has never been reported previously...
June 24, 2016: Journal of Neurosurgery
V Dclreux, L Kevers, A Callewaert
The authors report a case of pituitary apoplexy whose sole clinical manifestation was painful ophtalmoplegia. No other neurological, endocrine or visual symptoms were present. The classic investigations (radiological findings as computed tomography, endocrine and visual investigations, biology) were normal. The reasons of this are the small size of the pituitary adenoma, the absence of upward enlargment or secretion. This case illustrates the carefulness necessary before concluding to the Tolosa-Hunt syndrome and the ophthalmoplegia migraine, which are diagnoses of exclusion of painful ophthalmoplegia...
January 1988: Acta Clinica Belgica
Ilko Kastirr, Peter Kamusella, Reimer Andresen
We present the case of a man of 47 years with vertical and horizontal paresis of view combined with periorbital pain that developed initially on the right side but extended after 3-4 days to the left. Gadolinum uptaking tissue in the cavernous sinus was shown by MRI of the orbital region in the T1 spin echo sequence with fat saturation (SEfs) with a slice thickness of 2 mm. As no other abnormalities were found and the pain resolved within 72 hours of treatment with cortison a bilateral Tolosa-Hunt Syndrome (THS) was assumed...
March 2016: Journal of Clinical and Diagnostic Research: JCDR
Glenmore Lasam, Sakshi Kapur
We report a case of a 50-year-old female with diabetes mellitus who presented with progressive second, third, fifth, sixth, and eighth cranial nerve palsy. Diagnostic investigation revealed hyperglycemic state, and brain imaging showed a right cavernous sinus enhancement suggestive of and consistent with Tolosa-Hunt syndrome. The patient was started on steroids with tight glycemic control for eight weeks; subsequently, the cranial nerve palsies resolved as well as documented resolution of the right cavernous sinus enhancement...
2016: Case Reports in Medicine
Diana G Douleh, Peter J Morone, Joyce E Johnson, Paisit Paueksakon, John C Wellons Iii
Tolosa-Hunt syndrome is an idiopathic inflammatory process of the cavernous sinus or orbit manifesting as painful ophthalmoplegia. In this report, we detail the case of a 6-year-old boy who presented with several weeks of unilateral headache and diplopia. He was found to have an infiltrative process involving the bilateral cavernous sinuses and pituitary gland on MRI. Given a progressing infiltrative central nervous system process on repeat MRI and the development of cerebral salt wasting, a biopsy was performed revealing actinomycosis...
2016: Pediatric Neurosurgery
Ferda İlgen Uslu, Mustafa Özkan
Painful ophthalmoplegia consists of periorbital or hemicranial pain with ipsilateral ocular motor nerve palsies. There are many etiologies of painful ophthalmoplegia. Tolosa-Hunt syndrome (THS) is an uncommon disease caused by non-specific inflammation of the cavernous sinus, superior orbital fissure and the apex of the orbit. A 45-year-old female reported episodes of reversible left eye pain and diplopia. Examination showed periorbital oedema and left palpebral semiptosis, paresis of the partial left third nerve palsy with normal pupillary reactions, fourth and sixth left cranial nerves, and hypoesthesia over the first and second division of the left trigeminal nerve...
2015: Aǧrı: Ağrı (Algoloji) Derneği'nin Yayın Organıdır, the Journal of the Turkish Society of Algology
C Höhne, E Schuh, T Kümpfel, A Straube
BACKGROUND: Tolosa-Hunt syndrome (THS) is characterized by unilateral orbital pain, ipsilateral oculomotor paresis and a prompt response to treatment with corticosteroids. Several reports have demonstrated that the clinical features of THS are not specific to one causal aetiology and can lead to misdiagnosis. CASE REPORT: We report the case of a patient diagnosed with THS after an episode of unilateral orbital pain and diplopia with demonstration of granulomatous inflammation of both cavernous sinus on cerebral magnetic resonance imaging and an immediate response to treatment with corticosteroids...
February 3, 2016: Cephalalgia: An International Journal of Headache
Marcelo D Mendonça, Marta Guedes, Gonçalo Matias, João Costa, Miguel Viana-Baptista
INTRODUCTION: Tolosa-Hunt syndrome (THS) is one of the most common 'benign' causes of painful ophthalmoplegia. Diagnosis is based on clinical and imaging findings and the exclusion of other causes because there is no specific biomarker for the syndrome. Eales disease, an idiopathic inflammatory venous disease that primarily affects the eye, can also affect the central (as stroke or myelitis) and peripheral nervous system. CASE REPORT: We report the case of a 32-year-old woman with a subacute left ophthalmoplegia and evidence of a gadolinium-enhanced lesion suggesting an inflammatory granuloma that resolved within 48 hours after treatment with steroids...
February 2, 2016: Cephalalgia: An International Journal of Headache
Jong-Myong Lee, Jung-Soo Park, Eun-Jeong Koh
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.
January 2016: Acta Neurochirurgica
Andras A Kemeny
No abstract text is available yet for this article.
January 2016: Acta Neurochirurgica
Adeel Arshad, Shahzaib Nabi, Muhammad Siyab Panhwar, Ali Rahil
Tolosa-Hunt syndrome, an idiopathic granulomatous inflammation of the cavernous sinus, is primarily a diagnosis of exclusion. The majority of patients present with unilateral orbital pain and features suggestive of paralysis of one or more of the cranial nerves passing through the cavernous sinus and/or superior orbital fissure. MRI of the head may show unilateral enhancement of the cavernous sinus and orbital apex. Treatment is with high-dose intravenous steroids followed by tapering oral steroids. Rapid amelioration of pain within 24-48 h supports this rare diagnosis...
August 20, 2015: BMJ Case Reports
Deborah I Friedman
PURPOSE OF REVIEW: This article highlights painful conditions involving the eyes that are encountered in practice, emphasizing those that do not have obvious findings on the neurologic examination. RECENT FINDINGS: Peripheral and central sensitization are associated with chronic neuropathic ocular pain, and hyperalgesia is associated with dry eyes. The aorta and its branches are involved in 25% of patients with giant cell arteritis. SUMMARY: Eye pain is a common concern and one of the most difficult symptoms for the clinician to evaluate...
August 2015: Continuum: Lifelong Learning in Neurology
Partha S Ghosh
No abstract text is available yet for this article.
July 2015: JAMA Pediatrics
M Empar Blanco-Cantó, Pablo Dávila-González, Carlos López de Silanes, M Luz Cuadrado-Pérez, Gloria Ortega, Jesús Porta-Etessam
INTRODUCTION: Pathologies related to lymphocyte infiltration and inflammatory cells are classified, according to their topography, into idiopathic orbital pathology, idiopathic hypertrophic pachymeningitis, Tolosa-Hunt syndrome and lymphocytic hypophysitis. Here we review the case of a female patient who began with lymphocytic hypophysitis eight years ago and has since presented several episodes of hypertrophic pachymeningitis in a variety of locations. CASE REPORT: Our study involves a 55-year-old female, being monitored owing to a two-month history of headaches, who was admitted to hospital as the result of a deterioration of her clinical signs and symptoms with paralysis of the whole right-side third cranial nerve, watery eyes and rhinorrhea...
June 1, 2015: Revista de Neurologia
Tarek A Shazly, Ellen B Mitchell, Gabrielle R Bonhomme, Joel S Schuman
BACKGROUND: Tolosa-Hunt syndrome is a rare clinical syndrome characterized by painful ophthalmoplegia and ipsilateral cranial neuropathies. It is caused by an inflammatory process of unknown etiology. CASE PRESENTATION: We present a case of a 77-year-old white man with history of Waldenstrom's macroglobulinemia transforming to large B-cell lymphoma who presented to a community physician complaining of 4 months of isolated right retro-orbital pain and later with diplopia, ptosis, 6th nerve and pupil-sparing partial 3rd nerve palsies as well as progressive neurological findings...
2015: BMC Ophthalmology
Prakash Peddi, Kevin M Gallagher, Chandrikha Chandrasekharan, Qi Wang, Eduardo Gonzalez-Toledo, Binu S Nair, Reinhold Munker, Glenn M Mills, Nebu V Koshy
Tolosa-Hunt syndrome (THS) is a painful condition characterized by hemicranial pain, retroorbital pain, loss of vision, oculomotor nerve paralysis, and sensory loss in distribution of ophthalmic and maxillary division of trigeminal nerve. Lymphomas rarely involve cavernous sinus and simulate Tolosa-Hunt syndrome. Here we present a first case of double-hit B cell lymphoma (DHL) relapsing and masquerading as Tolosa-Hunt syndrome. The neurological findings were explained by a lymphomatous infiltration of the right Gasserian ganglion which preceded systemic relapse...
2015: Case Reports in Oncological Medicine
Rui Hao, Yanjin He, Hong Zhang, Wei Zhang, Xiaorong Li, Yifeng Ke
The objective of the study was to evaluate the amended International Classification of Headache Disorders (third edition, beta version, ICHD-3 beta) with a retrospective analysis. A total of 22 patients diagnosed with painful ophthalmoplegia and Tolosa-Hunt syndrome (THS) in our hospital were retrospectively studied. The following clinical data were collected: symptoms, signs, location of inflammatory tissue, time interval of paresis following the onset of pain, pain and signs of resolution, follow-up and relapse...
June 2015: Neurological Sciences
Chih-Hsien Hung, Kuo-Hsuan Chang, Yao-Liang Chen, Yi-Ming Wu, Chiou-Lian Lai, Hong-Shiu Chang, Rong-Kuo Lyu, Yih-Ru Wu, Chiung-Mei Chen, Chin-Chang Huang, Chun-Che Chu, Chun-Hung Chen, Long-Sun Ro
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...
February 2015: Headache
Daisuke Yamamoto, Emiko Tsuda, Masaki Saitoh, Tomihiro Imai, Shun Shimohama
A 30-year-old woman was admitted to our hospital because of intractable orbital pain and ptosis on the left side. On admission, she had left oculomotor, ophthalmic and maxillary nerves palsy. MRI revealed a contrast enhanced lesion of the left oculomotor and trigeminal nerves through the covernous sinus and orbita. We diagnosed her condition as Tolosa-Hunt syndrome. The orbital pain was resolved within 48-hours by the pulse therapy with intra-venous methylpredonisolone. The cranial nerve palsy was gradually improved, but never reached complete remission...
2014: Rinshō Shinkeigaku, Clinical Neurology
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