Tolosa-Hunt综合征10例临床诊治分析

Clinical diagnosis and treatment analysis of 10 patients with painful ophthalmoplegia syndrome

目的研究Tolosa-Hunt综合征(THS)的病因、诊断及治疗。方法收集2010年至2014年住院诊断10例Tolosa-Hunt综合征患者的临床表现、神经影像学、实验室检查及激素治疗情况并进行回顾性分析。结果 10例患者的颅神经麻痹累及动眼神经、滑车神经、外展神经及三叉神经第1、2、3支,有1例为完全性动眼神经麻痹。10例患者神经影像学分类均为良性的,应用激素后疼痛快速减轻,仅有1例遗留轻度复视。对治疗反应无年龄及性别差异。应用激素后10例患者疼痛均较眼肌麻痹缓解快。结论 THS的诊断为排他性,神经影像学对于鉴别诊断THS非常重要,对于THS病人应全面完善检查除外其他疾病引起的疼痛性眼肌麻痹,包括血常规、红细胞沉降率、C反应蛋白、甲状腺、肝肾功能检查、胸片、头部及眼眶部CT及磁共振检查。

Objective To study the etiology,diagnosis and treatment of Tolosa- Hunt syndrome. Methods The data of clinical manifestations,neuroimaging,laboratory examinations and the therapeutic effect by steroid from ten patients with Tolosa- Hunt syndrome,hospitalized from 2010 to 2015,were retrospectively analyzed. Results The ten patients of our study involve paresis of one or more of the third,fourth,fifth and sixth cranial（ VI1,VI2 and VI3）. One case showed complete oculomotor nerve paralysis. The ten cases of THS can be classified as benign according to neuroimaging [when no abnormal neuroimaging can be found]. Our study revealed that the rapid alleviation of pain by steroid treatment was a characteristic feature of THS patients. Only one patient essentially remained mild diplopia. No age and gender differences was found in response to the treatment. We noticed that the time course of symptom relief differed between pain and palsy,with pain relief occurring with a much faster time course. Conclusion THS essentially remained a diagnosis of exclusion. Neuroimaging was important in differential diagnosis.Also full blood count,ESR,C reactive protein,full biochemistry tests including thyroid and liver functional tests and Chest X ray were indicated.Brain and orbital imaging included MRI and CT scan.