Painful ophthalmoplegia: a case report and literature

Ağrılı oftalmopleji periorbital veya hemikranyal başa ağrısı ile beraber ipsilateral okular motor sinir parezileri ile karakterizedir ve birçok değişik etiyoloji sonucu oluşabilir. Tolosa-Hunt Sendromu (THS) ağrılı oftalmopatiye neden olabilen, kavernöz sinus, superior orbital fissur ve orbat apeksinin nonspesifik inflamasyonu sonucu oluşan nadir bir hastalıktır. Burada sol göz ağrısı ve diplopi ile başvuran 45 yaşında kadın hasta sunuldu. Muayenesinde periorbital ödem ve sol palpebral semiptoz, sol parsiyel 3. kranyal sinir felci, 4., 6. felci ve 5. sinir oftalmik ve maksiller divizyon alanında hiposetezi saptandı. Kan analizi, postkontrast kraniyal ve orbital magnetik resonans görüntülemesi ve BOS incelemesinde patoloji saptanmadı. Klinik tanısı THS kriterleri- ni dolduruyordu. Steroid tedavisi sonrası semptom ve bulguları tamamen düzeldi. Ağrılı oftalmopleji THS gibi enflamatuvar durumlar ile birlikte olabilir ve bu durumda steroid tedavisine tam aynıtlıdır, fakat mutlaka iyi bir ayırıcı tanı yapılmalıdır. THS tanısı nadiren kullanılması gereken bir tanıdır.

Ağrılı oftalmopleji: Bir olgu sunumu ve literatür gözden geçirmesi

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 inflam- mation 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. Blood analysis, postcontrast cranial and orbital magnetic resonance (MR) imaging, cranial MR angiography and CSF analysis demonstrated no abnormalities. The clinical diagnosis satisfies the criteria for THS. After steroid therapy her symptoms and clinical signs dramatically reverses. Painful ophthalmoplegia with inflamma- tory conditions such as THS is highly responsive to corticosteroids but should be diagnoses of exclusion. The THS diagnosis should be used rarely and with great caution

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