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Query: UMLS:C0027121 (myositis)
 4,538 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tolosa-Hunt syndrome and orbital myositis have common features such as ocular pain, ophthalmoplegia and exophthalmos. Both syndromes are thought to be caused by a granulomatous inflammation involving the cavernous sinus area in the former and the orbital cavity in the latter. The question whether these two conditions represent different presentations of a single disease, or they belong to different entities has not been settled. To address this question, we reviewed our cases having clinical diagnosis of either Tolosa-Hunt syndrome or orbital myositis. Six cases were diagnosed as Tolosa-Hunt syndrome, and 7 orbital myositis. In the thin-slice enlarged orbital CT, hypertrophic and high-density changes of at least one of the extraocular muscles were found in all cases with orbital myositis, but in none of the patients with Tolosa-Hunt syndrome. The age of onset was younger and the duration of the disease before admission was shorter in Tolosa-Hunt syndrome. They responded to steroid therapy better than those with orbital myositis. These findings lead us to conclude that Tolosa-Hunt syndrome and orbital myositis belong to different syndromes, although clinical manifestations have many similarities. Then we studied the relationship between the hypertrophic change of the extraocular muscle and the direction of the oculomotor restriction. For this purpose four additional cases with dysthyroid ophthalmopathy were also studied. We found that the presence of hypertrophic change was frequently associated with the restriction of ocular movement to the direction not only of the hypertrophic muscle but also of the opposite muscle.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical and neuroradiological studies on orbital myositis and Tolosa-Hunt syndrome]. 142 37

A case of acute orbital myositis is presented in this report. CT scanning provided an immediate diagnosis and hence institution of treatment. There was a typically rapid response to steroids. A previous presentation, prior to the advent of CT, had been misdiagnosed as Tolosa-Hunt syndrome. Orbital pseudotumour can be acute or chronic, and acute orbital myositis is now regarded as one of five subtypes of the former.
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PMID:Acute orbital myositis: a case report. 407 56

The clinical diagnosis of Tolosa-Hunt syndrome was first considered in a 66-year-old man with facial pain and diplopia. A complete neuroradiologic evaluation as well as an oncologic work-up yielded normal results. Several courses of oral prednisone provided no significant benefit. Within a year the patient became clinically worse and a CT scan disclosed an abnormal area of enhancement at the left orbital apex. An orbital exploration was performed elsewhere and a histologic diagnosis of myositis was obtained. Because of further worsening the patient was re-evaluated 3 months later and a CT scan showed a mass in the left orbital apex and superior orbital fissure. A second orbital exploration was performed and a sausage-shaped mass encompassing the optic nerve was excised. By light microscopy a poorly differentiated malignant tumor was infiltrating the orbital tissues with areas of intra- and perineural invasion. The tumor cells were arranged in strands and tubules with a definite tendency to form lumens that often contained red blood cells. Electron microscopic studies disclosed features consistent with a neoplasm of endothelial cell origin displaying a polarized basal lamina and rare micropinocytotic vesicles on the luminal side. The presence of multiple, slender microvilli and sometimes tonofilaments as well as desmosomes were interpreted as epithelioid metaplasia of an angiosarcoma.
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PMID:Epithelioid angiosarcoma of the orbit presenting as Tolosa-Hunt syndrome. A clinicopathologic case report with review of the literature. 668 55

Twenty adult patients with orbital pseudotumor were studied with orbital venography and magnification arteriography. Computed tomography (CT) scans were obtained in 14 patients. Occlusive and constrictive changes of the proximal segments of the superior ophthalmic veins were the most frequent vascular abnormalities. The affected ophthalmic arteries were often attenuated but not occluded. Myositis and surrounding connective tissue inflammatory changes are thought to result in sufficient mass effect to cause the venous stasis with narrowing and subsequent occlusion. Such venographic changes are not distinctive for orbital pseudotumor but may also be seen in cases of thyrotoxicosis, Tolosa-Hunt syndrome, and orbital tumors.
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PMID:Orbital pseudotumor: association of orbital vein deformities and myositis. 677 6

The purpose of this study was to review our clinical experience with 132 idiopathic orbital inflammation cases seen between 1971 and 1994. Clinical charts of the patients were evaluated retrospectively. Patient age ranged from 5 to 80 (mean 46.5) years. The follow-up period was between 6 to 172 (mean 42.8) months. Proptosis (82%), motility restriction (54%), visual acuity loss (38%) were the three more common presenting signs. The diagnosis was made by open biopsy in 96 cases and clinically in 36 cases. Radiologic patterns of involvement were available for 84 cases. Diffuse inflammatory disease (40 cases) was the most frequent radiologic pattern followed by myositis (21 cases) and dacryoadenitis (14 cases). Focal encapsulated mass (5 cases), Tolosa-Hunt syndrome (2 cases) perineuritis (1 case) and periscleritis (1 case) were the other types of orbital pseudotumors. The response to treatment was known for 60 of the 84 radiologically classified cases. High-dose oral corticosteroid treatment was successful in 35 out of 60 (58.3%) cases and radiotherapy in 9 out of 14 (64.3%) cases resistant to corticosteroids. One resistant case responded to cyclophosphamide and 2 cases with focal mass lesions were treated with orbitotomy. Four additional cases had spontaneous remission. Overall, 51 out of 64 patients (79.7%) had an eventual good outcome. In conclusion, we found open biopsy to be a safe and reliable procedure in orbital pseudotumors with the exclusion of acute phase cases. The success rate of treatment for this group of orbital disorders is high with the exception of certain disease patterns.
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PMID:Idiopathic orbital inflammatory disease. 873 89

Pseudotumor, Graves' disease, and lymphoproliferative disease are the most common ophthalmologic disease entities requiring evaluation by CT and MR imaging. A history of acute onset, pain, swelling, proptosis, and response to steroids are the classical findings. The radiologic findings are categorized according to location into dacryoadenitis, myositis, and sclerouveitis, with and without associated infiltrations. The inflammatory infiltrate, which is composed of polymorphic leukocytes, lymphocytes, and plasma cells interspersed with a variable amount of fibrovascular tissue, may be diffuse or localized. The preferred radiologic method used for assessment of pseudotumor is CT. MR imaging, however, is indicated for evaluation of the Tolosa-Hunt syndrome, which is characterized by an inflammatory infiltrate in the orbital apex and cavernous sinus leading to cranial nerve involvement with ophthalmoplegia. The clinical and radiologic constellation of findings allows a definitive diagnosis in most cases.
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PMID:Pseudotumor of the orbit. Clinical, pathologic, and radiologic evaluation. 1002 35