Tolosa-Hunt综合征临床及影像学分析

发布时间：2018-02-23 18:23

本文关键词： Tolosa-Hunt综合征海绵窦磁共振成像　出处：《中风与神经疾病杂志》2015年07期 　论文类型：期刊论文

【摘要】：目的探讨Tolosa-Hunt综合征(THS)的临床、影像学表现及治疗,提高对该病的诊治水平。方法对12例THS患者的临床表现、实验室检查、神经影像学结果、治疗方法及转归进行回顾性分析。结果 12例患者多为亚急性起病,2例眼肌麻痹与头痛同时发生、10例在头痛后14 d内出现;9例动眼神经麻痹、6例外展神经麻痹、2例滑车神经麻痹、2例视神经受累;血常规、血沉、脑脊液压力、常规、生化检查基本正常;MRI检查显示12例患侧海绵窦区软组织增厚、4例患侧眶上裂软组织增厚,病灶呈均匀性强化。所有患者激素治疗后10~72 h内疼痛缓解,11例用药后4~60(29.7±18.0)d体征完全恢复,1例遗留脑神经麻痹。结论 THS的头痛可先于眼肌麻痹2 w或同时发生,血常规、血沉和脑脊液检查对诊断缺乏特异性提示,海绵窦MRI对诊断有重要价值,激素治疗效果明显,但体征恢复比疼痛缓解需要更长时间。
[Abstract]:Objective to investigate the clinical, imaging manifestations and treatment of Tolosa-Hunt syndrome, and to improve the diagnosis and treatment of THS.Methods the clinical manifestation, laboratory examination and neuroimaging results of 12 patients with THS were studied. Results 12 cases were mostly subacute onset, 2 cases of ophthalmoplegia and headache occurred simultaneously in 10 cases, 9 cases of oculomotor palsy occurred within 14 days after headache and 6 cases of abducens nerve palsy. The optic nerve was involved in 2 cases. Routine examination, erythrocyte sedimentation rate (ESR), cerebrospinal fluid pressure (CSF) pressure, routine and biochemical examination showed that 12 cases had soft tissue thickening in cavernous sinus area and 4 cases had supraorbital fissure. The focus showed homogeneous enhancement. 11 patients with pain relief within 1072 hours after steroid therapy had complete recovery of 1 patient's left cerebral palsy. Conclusion the headache of THS can occur before or at the same time of ophthalmoplegia, and the blood routine examination shows that the headache of THS can occur earlier than that of ophthalmoplegia for 2 weeks or at the same time. Erythrocyte sedimentation rate and cerebrospinal fluid examination were not specific for diagnosis. Cavernous sinus MRI had important value in diagnosis. Hormone therapy was effective, but the recovery of signs took longer than that of pain relief.
【作者单位】：长沙市中心医院神经内科;湖南省人民医院神经内科;长沙市中心医院放射科;
【基金】：湖南省科技厅资助项目(No.2013FJ3119)
【分类号】：R777.45

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