易误诊为Tolosa-Hunt综合征的疾病特点分析

Analysis of disease characteristics easily misdiagnosed as Tolosa-Hunt syndrome

目的总结易误诊为Tolosa-Hunt综合征(THS)的疾病,并进行鉴别分析。方法回顾性系列病例研究。收集2020年1月至2021年12月期间在空军军医大学第二附属医院眼科就诊,临床表现类似典型THS的患者相关资料,通过眼眶MRI/CT检查、头颈部血管成像(CTA)、全脑血管造影(DSA)、手术活检等明确病因,并分析临床特征。结果共8例患者,平均年龄48.9岁(32~71岁),男性3例,女性5例,左眼5例,右眼3例。(1)病因:颈动脉海绵窦瘘(CCF)1例、颅内后交通动脉瘤1例、颅内动脉瘤术后1例、眶上裂及海绵窦感染性肉芽肿1例、眼眶内腺样囊性癌1例、颅底及眶尖低分化腺癌1例、小细胞肺癌眶内及海绵窦转移1例、侵袭性霉菌性鼻窦炎1例。(2)临床表现:偏侧头痛及眶周疼痛(8例,100%),眼球运动受限(8例,100%),上睑下垂(8例,100%),视力受损(6例,75%),眼球突出(4例,50%),瞳孔散大1例(12.5%)。(3)治疗效果:CCF、颅内后交通动脉瘤、颅内动脉瘤术后、侵袭性霉菌性鼻窦炎患者经过手术联合药物对症治疗,效果良好;其余4例患者通过手术及其它辅助治疗,最终疗效差。结论THS的临床表现具有非特异性,其他疾病(肿瘤、感染、血管病变等)易误诊为THS。因此,对于非典型的THS患者,需及时排查其它病因,必要时手术活检,避免遗漏。

Objective To summarize the diseases easily misdiagnosed as Tolosa-Hunt syndrome(THS),and make differential analysis.Methods A retrospective series of case studies.The relevant data of patients with clinical manifestations similar to typical ths in the Department of Ophthalmology of the Second Affiliated Hospital of Air Force Military Medical University from January 2020 to December 2021 were collected.The etiology was determined by orbital MRI/CT,head and neck angiography(CTA),whole brain angiography(DSA),surgical biopsy and clinical characteristics were analyzed.Results There were 8 patients,with an average age of 48.9 years(32~71 years),3 males and 5 females.Eye type:5 cases in the left eye and 3 cases in the right eye.(1)Etiology:1 case of carotid cavernous fistula(CCF),1 case of intracranial posterior communicating aneurysm,1 case of intracranial aneurysm after operation,1 case of infectious granuloma of supraorbital fissure and cavernous sinus,1 case of intraorbital adenoid cystic carcinoma,1 case of poorly differentiated adenocarcinoma of skull base and orbital apex,1 case of orbital and cavernous sinus metastasis of small cell lung cancer,and 1 case of invasive fungal sinusitis.(2)Clinical manifestations:unilateral headache and periorbital pain(8 cases,100%),limited eye movement(8 cases,100%),ptosis(8 cases,100%),impaired vision(6 cases,75%),exophthalmos(4 cases,50%),mydriasis(1 case,12.5%).(3)Treatment effect:Patients with CCF,intracranial posterior communicating aneurysm,intracranial aneurysm after operation and invasive fungal sinusitis were treated with surgery combined with drugs;The other 4 patients had poor final curative effect through surgery and other adjuvant treatment.conclusions The clinical manifestations of THS are nonspecific,and other diseases(tumors,infections,vascular diseases,etc.)are easy to be misdiagnosed as THS.Therefore,for atypical THS patients,it is necessary to investigate other causes in time and conduct surgical biopsy if necessary to avoid omission.