62例Tolosa-Hunt综合征患者的临床分析
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摘要
目的分析Tolosa-Hunt综合征患者的临床特点及预后情况。方法收集2008年6月至2018年6月山东省立医院神经内科收治的62例Tolosa-Hunt综合征患者的临床资料,对其进行分析总结。结果 62例患者中,男性34例,女性28例,83.9%的患者发病年龄在40～79(中位数为61.5)岁。66.1%患者以头面痛或头痛伴随颅神经麻痹症状起病,常见临床表现依次为头面痛61例(98.4%)、眼球运动障碍50例(80.7%)、视物重影47例(75.8%)、眼睑下垂43例(69.4%)。在头痛及颅神经麻痹症状的预后方面,完全缓解组与未完全缓解组在性别、年龄、吸烟、饮酒、住院时间,及有无高血压、糖尿病等方面均无统计学差异。回归分析结果显示,白细胞计数、起始激素治疗剂量及静脉激素治疗时间与患者预后无关。结论 Tolosa-Hunt综合征的特征性表现为头面痛和眼肌麻痹,诊断应仔细询问病史、进行全面查体并结合影像学检查综合分析。
Objective To analyze the clinical features and prognosis of patients with Tolosa-Hunt syndrome(THS).Methods The clinical data of 62 patients with THS admitted to department of neurology of Shandong Provincial Hospital from June 2008 to June 2018 were retrospectively analyzed and summarized.Results Among the 62 subjects, 34 cases were male and 28 cases were female, and 83.9% patients had an onset age of 40-79 years(median age of patients was 61.5). At the onset of illness, 66.1% of patients showed symptoms of headache or headache accompanied by symptoms of cranial nerve palsy. Common clinical manifestations were headache in 61 cases(98.4%), eye movement disorders in 50 cases(80.7%), visual ghosting in 47 cases(75.8%), and blepharoptosis in 43 cases(69.4%). In terms of the prognosis of headache and cranial nerve palsy symptoms, there was no statistical difference in gender, age, smoking, drinking, length of hospital stay, and whether they had hypertension and diabetes between complete remission group and incomplete remission group; Regression analysis showed that white blood cell count, starting hormone therapeutic dose and venous hormone treatment time had nothing to do with the patient's prognosis. Conclusions Tolosa-Hunt syndrome is characterized by headache and ophthalmoplegia. The diagnosis should be carefully asked for medical history, comprehensive examination and combined with imaging analysis.
Objective To analyze the clinical features and prognosis of patients with Tolosa-Hunt syndrome(THS).Methods The clinical data of 62 patients with THS admitted to department of neurology of Shandong Provincial Hospital from June 2008 to June 2018 were retrospectively analyzed and summarized.Results Among the 62 subjects, 34 cases were male and 28 cases were female, and 83.9% patients had an onset age of 40-79 years(median age of patients was 61.5). At the onset of illness, 66.1% of patients showed symptoms of headache or headache accompanied by symptoms of cranial nerve palsy. Common clinical manifestations were headache in 61 cases(98.4%), eye movement disorders in 50 cases(80.7%), visual ghosting in 47 cases(75.8%), and blepharoptosis in 43 cases(69.4%). In terms of the prognosis of headache and cranial nerve palsy symptoms, there was no statistical difference in gender, age, smoking, drinking, length of hospital stay, and whether they had hypertension and diabetes between complete remission group and incomplete remission group; Regression analysis showed that white blood cell count, starting hormone therapeutic dose and venous hormone treatment time had nothing to do with the patient's prognosis. Conclusions Tolosa-Hunt syndrome is characterized by headache and ophthalmoplegia. The diagnosis should be carefully asked for medical history, comprehensive examination and combined with imaging analysis.
引文
[1] Kline LB,Hoyt WF.The Tolosa-Hunt syndrome[J].J Neurol Neurosurg Psychiatry,2001,71(5):577-582.
[2] Arnold M.Headache classification committee of the international headache society (IHS) the international classification of headache disorders,3rd edition[J].Cephalalgia,2018,38(1):1-211.
[3] Gladstone JP,Dodick DW.Painful ophthalmoplegia:overview with a focus on Tolosa-Hunt syndrome[J].Curr Pain Headache Rep,2004,8(4):321-329.
[4] Oomura M,Uchida Y,Sakurai K,et al.Miller Fisher syndrome mimicking Tolosa-Hunt syndrome[J].Intern Med,2018,57(18):2735-2738.
[5] Olesen J,Steiner TJ.The International classification of headache disorders,2nd edn (ICDH-Ⅱ)[J].J Neurol Neurosurg Psychiatry,2004,24(8):1381-1382.
[6] Jarholm JA,Faiz KW,Nysted T,et al.Orbital pain,ophthalmoplegia,and oligoclonal bands in the cerebrospinal fluid:A case report of Tolosa-Hunt syndrome[J].Headache,2018,58(5):758-760.
[7] Hung CH,Chang KH,Wu YM,et al.A comparison of benign and inflammatory manifestations of Tolosa-Hunt syndrome[J].Cephalalgia,2013,33(10):842-852.
[8] Tessitore E,Tessitore A.Tolosa-Hunt syndrome preceded by facial palsy[J].Headache,2010,40(5):393-396.
[9] 刘炫君,杨国帅,程启慧,等.以面部感觉障碍为首发表现的痛性眼肌麻痹诊治分析[J].临床误诊误治,2017,30(9):21-22.
[10] 高海凤,李永秋,马建国.伴同侧面神经麻痹的复发性痛性眼肌麻痹1例报告[J].临床神经病学杂志,2008,21(4):266-266.
[11] Iaconetta G,Stella L,Esposito M,et al.Tolosa-Hunt syndrome extending in the cerebello-pontine angle[J].Cephalalgia,2010,25(9):746-750.
[12] Zhang X,Zhou Z,Steiner TJ,et al.Validation of ICHD-3 beta diagnostic criteria for 13.7 Tolosa-Hunt syndrome:analysis of 77 cases of painful ophthalmoplegia[J].Cephalalgia,2014,34(8):624- 632.
[13] Mullen E,Green M,Hersh E,et al.Tolosa-Hunt syndrome:appraising the ICHD-3 beta diagnostic criteria[J].Cephalalgia,2017,38(10):1696-1700.
[14] Aidara CM,Kouna P,Mapaga JN,et al.High-field MRI contribution in Tolosa-Hunt Syndrome (THS).Report of two cases and review of literature[J].OJ Rad,2018,8(03):141-149.
[15] Mantia LL,Curone M,Rapoport AM,et al.Tolosa-Hunt syndrome:critical literature review based on IHS 2004 criteria[J].Cephalalgia,2006,26(7):772-781.
[16] Hung CH,Chang KH,Chu CC,et al.Painful ophthalmoplegia with normal cranial imaging[J].BMC Neurol,2014,14(1):7-7.
[17] Zhang X,Zhang W,Liu R,et al.Factors that influence Tolosa-Hunt syndrome and the short-term response to steroid pulse treatment [J].J Neurol Sci,2014,341(1-2):13-16.
[18] Ishikawa R,Ishikawa Y,Kubota T,et al.A case of delirium in Tolosa-Hunt syndrome during corticosteroid therapy[J].JA Clin Rep,2018,4(1):58-61.
[2] Arnold M.Headache classification committee of the international headache society (IHS) the international classification of headache disorders,3rd edition[J].Cephalalgia,2018,38(1):1-211.
[3] Gladstone JP,Dodick DW.Painful ophthalmoplegia:overview with a focus on Tolosa-Hunt syndrome[J].Curr Pain Headache Rep,2004,8(4):321-329.
[4] Oomura M,Uchida Y,Sakurai K,et al.Miller Fisher syndrome mimicking Tolosa-Hunt syndrome[J].Intern Med,2018,57(18):2735-2738.
[5] Olesen J,Steiner TJ.The International classification of headache disorders,2nd edn (ICDH-Ⅱ)[J].J Neurol Neurosurg Psychiatry,2004,24(8):1381-1382.
[6] Jarholm JA,Faiz KW,Nysted T,et al.Orbital pain,ophthalmoplegia,and oligoclonal bands in the cerebrospinal fluid:A case report of Tolosa-Hunt syndrome[J].Headache,2018,58(5):758-760.
[7] Hung CH,Chang KH,Wu YM,et al.A comparison of benign and inflammatory manifestations of Tolosa-Hunt syndrome[J].Cephalalgia,2013,33(10):842-852.
[8] Tessitore E,Tessitore A.Tolosa-Hunt syndrome preceded by facial palsy[J].Headache,2010,40(5):393-396.
[9] 刘炫君,杨国帅,程启慧,等.以面部感觉障碍为首发表现的痛性眼肌麻痹诊治分析[J].临床误诊误治,2017,30(9):21-22.
[10] 高海凤,李永秋,马建国.伴同侧面神经麻痹的复发性痛性眼肌麻痹1例报告[J].临床神经病学杂志,2008,21(4):266-266.
[11] Iaconetta G,Stella L,Esposito M,et al.Tolosa-Hunt syndrome extending in the cerebello-pontine angle[J].Cephalalgia,2010,25(9):746-750.
[12] Zhang X,Zhou Z,Steiner TJ,et al.Validation of ICHD-3 beta diagnostic criteria for 13.7 Tolosa-Hunt syndrome:analysis of 77 cases of painful ophthalmoplegia[J].Cephalalgia,2014,34(8):624- 632.
[13] Mullen E,Green M,Hersh E,et al.Tolosa-Hunt syndrome:appraising the ICHD-3 beta diagnostic criteria[J].Cephalalgia,2017,38(10):1696-1700.
[14] Aidara CM,Kouna P,Mapaga JN,et al.High-field MRI contribution in Tolosa-Hunt Syndrome (THS).Report of two cases and review of literature[J].OJ Rad,2018,8(03):141-149.
[15] Mantia LL,Curone M,Rapoport AM,et al.Tolosa-Hunt syndrome:critical literature review based on IHS 2004 criteria[J].Cephalalgia,2006,26(7):772-781.
[16] Hung CH,Chang KH,Chu CC,et al.Painful ophthalmoplegia with normal cranial imaging[J].BMC Neurol,2014,14(1):7-7.
[17] Zhang X,Zhang W,Liu R,et al.Factors that influence Tolosa-Hunt syndrome and the short-term response to steroid pulse treatment [J].J Neurol Sci,2014,341(1-2):13-16.
[18] Ishikawa R,Ishikawa Y,Kubota T,et al.A case of delirium in Tolosa-Hunt syndrome during corticosteroid therapy[J].JA Clin Rep,2018,4(1):58-61.