Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diagnosis of Tolosa-Hunt syndrome was made in a 25-year-old woman on the basis of unilateral third and sixth nerve paresis and possible involvement of the first branch of the ipsilateral trigeminal nerve, accompanied by headaches and ocular pain, which responded promptly to corticosteroid administration. Irregular narrowing of the right carotid siphon and occlusion of the homolateral superior ophthalmic vein were observed. During steroid therapy this stenosis improved in association with almost complete clinical recovery, although the vein was not recanalized. Of ten reported cases with contrast radiographic abnormalities, including our own, only two showed pupillary involvement. We hypothesize that the third nerve paresis with pupillary sparing in this syndrome may be attributable to the same underlying mechanism as that of diabetic ophthalmoplegia.
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PMID:Tolosa-Hunt syndrome. Arteriographic evidence of improvement in carotid narrowing. 63 55

In 1964, a 51-year-old man experienced a right abducens nerve palsy, which resolved spontaneously. In 1978, he developed painful ophthalmoplegia on the right with paresis of the right oculomotor and trigeminal nerves. Neuroradiographic evaluation was reported unremarkable, and the painful ophthalmoplegia was attributed to the Tolosa-Hunt syndrome. High-dose corticosteroids were administered with transient improvement of signs and symptoms. In 1979, cranial computerized tomography demonstrated a low-density lesion adjacent to the right cavernous sinus, which at operation proved to be an epidermoid tumor.
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PMID:Parasellar epidermoid tumor presenting as painful ophthalmoplegia. 746 10

A 23-year-old female with a six year history of migraine without aura twice developed a nearly complete internal and external III nerve paresis ipsilateral to her headache, two days after the onset of migraineous headache. An MR scan performed one week after the second episode showed a contrast enhanced lesion of the prepontine III nerve, where it enters the cavernous sinus on the left side. The headache, as well as the paresis ameliorated spontaneously. We suggest this is a further well documented case of "ophthalmoplegic migraine" which might reflect Tolosa-Hunt syndrome.
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PMID:A contrast enhanced lesion of the III nerve on MR of a patient with ophthalmoplegic migraine as evidence for a Tolosa-Hunt syndrome. 804 24

The patient, an otherwise healthy 42-year-old woman, developed non-throbbing periorbital pain and abducens nerve palsy of the right side two weeks prior to the present admission. Under the diagnosis of Tolosa-Hunt syndrome, she had been placed on prednisolone (30 mg/day) in another hospital, leading to exacerbation of her neurologic manifestations. On admission, neurologic examination revealed bilateral abducens nerve palsy, incomplete bilateral oculomotor paresis, and hypalgesia in the first and the second branch of the left trigeminal nerve. On CSF examination there were 742/mm3 white blood cells of which about 80% of the cells were neutrophils. The glucose was 70 mg/dl (blood glucose was 170 mg/dl) and the protein 49 mg/dl. Although repeated cultures for bacteria or fungi were negative, PAS stains for CSF sediments showed a large number of yeasts morphologically consistent with a Malassezia species. Anti-fungal treatment with fluconazole and flucytosine resulted in dramatic improvement both in neurologic signs and laboratory findings. According to morphological criteria, the yeasts found in CSF sediments from this patient differed from those described previously as being pathogenetic in the CNS fungal infection. By contrast, these yeasts were similar to a Malassezia species in all aspects. Because some Malassezia requires oil for its growth in culture, it is possible that it failed to grow in the standard media and thus escaped recognition.
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PMID:[Fungal meningitis caused by a Malassezia species masquerading as painful ophthalmoplegia]. 837 Feb 13

Two patients with retroorbital pain syndromes with or without paresis of cranial nerves developed weeks after ipsilateral headache resembling chronic paroxysmal hemicrania (CPH) but without autonomic features. These findings might support the hypothesis that CPH may be caused by a pathological process in the region of the cavernous sinus, as has been proposed for the Tolosa-Hunt syndrome (THS).
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PMID:A CPH-like picture in two patients with an orbitocavernous sinus syndrome. 925 79

In 1988 the International Headache Society defined the diagnostic criteria of Tolosa-Hunt syndrome (THS) to include episode(s) of unilateral orbital pain for an average of 8 weeks if untreated, with associated paresis of one or more of the third, fourth, and sixth cranial nerves. Cranial nerve paresis may coincide with the onset of pain or follow it within a period of up to 2 weeks, and the pain must be relieved within 72 h after the initiation of corticosteroid therapy. Other causative lesions must be excluded by neuroimaging. On the basis of the history and neuroradiological findings of six patients we show the pitfalls in diagnosing THS with these criteria. We propose a revision of the criteria: Other causative lesions must be excluded by neuroimaging, especially of the region of the cavernous sinus and the orbita, and by blood and CSF examinations. Since imaging techniques have dramatically improved, it is now possible to visualize the inflammatory tissue in THS. Positive magnetic resonance imaging or computed tomography findings compatible with inflammatory tissue neither exclude nor confirm THS and remain suspect until a malignant tumor or inflammation other than THS is excluded. Clinical and radiological follow-up examinations must be performed for at least 2 years, even in patients with negative findings on magnetic resonance imaging at onset.
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PMID:The criteria of the International Headache Society for Tolosa-Hunt syndrome need to be revised. 1039 69

Tolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia due to a granulomatous inflammation in the cavernous sinus. Corticosteroid therapy dramatically resolves both the clinical and radiological findings of THS. We present MRI findings of six patients with a clinical history of at least one episode of unilateral or bilateral orbital-periorbital pain, clinical findings of associated paresis of one or more of 3rd, 4th, 5th or 6th cranial nerves. All of the patients revealed an enlargement of the symptomatic cavernous sinus on magnetic resonance imaging (MRI) scans. Five patients revealed total resolution of the clinical findings within 1-8 weeks, following systemic corticosteroid treatment. One patient revealed only minor regression of clinical findings within 2 weeks after the initiation of the treatment, so the cavernous sinus lesion was reevaluated as meningioma on MRI, and the patient underwent surgical resection of the mass with resultant histopathological finding of cavernous sinus meningioma. A follow-up MRI scan was performed for five patients at the end of 8-weeks of steroid therapy. Three of these five patients showed total resolution of the cavernous sinus lesions whereas two of them revealed a partial regression of the cavernous sinus lesions. MRI findings before and after systemic corticosteroid therapy are important diagnostic criteria to put the definitive diagnosis of THS and to differentiate it from other cavernous sinus lesions that simulate THS both clinically and radiologically.
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PMID:MRI findings in Tolosa-Hunt syndrome before and after systemic corticosteroid therapy. 1253 85

The aim of this study was to present our experience in MRI diagnosis of 23 patients with the clinical findings suggesting Tolosa-Hunt syndrome (THS). Cranial MRI studies of the patients with a clinical history of at least one episode of unilateral or bilateral orbital and periorbital pain, and associated paresis of one or more of third to sixth cranial nerves, were performed on a 1.5-T MRI scanner. Whereas 5 patients had the diagnosis of THS, paracavernous meningiomas in 4 patients, pituitary macroadenomas with cavernous sinus infiltration in 3 patients, Meckel's cave neurinoma in 1 patient, and suprasellar epidermoid in 1 patient were surgically proven MRI findings. Other pathological MRI findings were leptomeningeal metastases in 3 patients, granulomatous pachymeningitis sequelae in 2 patients, and aneurysm with compression on cavernous sinus in 1 patient. Three patients had normal MRI findings. The incidence of radiologically proven diagnosis of THS among the patients with the clinical findings suggesting THS seemed to be low in our study. In conclusion, MRI is the most valuable imaging technique to distinguish THS from other THS-like entities, and permits a precise assessment, management, and therapeutic planning of the underlying pathological conditions.
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PMID:MRI findings in the patients with the presumptive clinical diagnosis of Tolosa-Hunt syndrome. 1254 Nov 6

We report a case with recurrent orbital pain and unilateral cranial nerve paresis mimicking Tolosa-Hunt syndrome. However, these features were most likely caused by bacterial infection because of beneficial response to antibiotics therapy. A 32-year-old man developed severe right orbital pain and diplopia. Neurological examination revealed right oculomotor paresis and 1st division of the right trigeminal nerve dysfunction. MR imaging revealed thickness of right cavernous sinus region with marked gadolinium enhancement. Cerebrospinal fluid (CSF) examination was initially normal. Treatment with steroid showed marked improvement. However soon after tapering of steroid dosage, his symptoms recurred and deteriorated. He was referred to our hospital because of second opinion. Neurological examination still showed right oculomotor paresis and 1st division of the right trigeminal nerve dysfunction with orbital and retro-orbital pain. Re-examination of CSF showed pleocytosis with neutrocytes dominancy and elevated protein concentration. Intravenous treatment with penicillin was initiated with marked improvement. There have been reported cases with bacterial infection resulting pseudo Tolosa-Hunt syndrome, which have good response to antibiotics treatment with excellent prognosis. It is speculated that bacterial infection might cause clinical features mimicking Tolosa-Hunt syndrome in our case.
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PMID:[A case of pseudo Tolosa-Hunt syndrome with bacterial infection and literature review]. 1637 93

A 40-year-old man underwent surgery for a right middle ear cholesteatoma. One month later, he presented with a subacute ocular pain that was followed one day later by the appearance of vertical diplopia attributable to a right superior rectus paresis, lid ptosis and hypoaesthesia in the territory of the I and the II right trigeminal branches. A fat-suppressed (selective partial inversion recovery, SPIR) gadolinium-enhanced MRI favours the detection of inflammatory pathological tissue inside the right cavernous sinus, and in this patient it suggested a diagnosis of Tolosa-Hunt syndrome. The pain disappeared quickly after steroid treatment was started whereas the ocular nerve involvement improved only slightly during the first week of treatment. After two months, the patient only complained of diplopia on up-gaze, but the therapy was discontinued two months later on the basis of both clinical signs and MRI findings. SPIR MRI may be useful not only to support a diagnosis of Tolosa-Hunt syndrome, but also to follow-up the disease course and to manage steroid treatment.
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PMID:SPIR MRI usefulness for steroid treatment management in Tolosa-Hunt syndrome. 1681 14


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