Tolosa-Hunt综合征的临床特点、影像学研究及病因分析  

Study on the etiology and neuroimaging exam inations of Tolosa-Hunt syndrome

作　　者：管小亭[1] 于学英[1] 藏大维[1] 沈言修[1] 尚京伟[2] 何雁[2] 

机构地区：[1]首都医科大学附属天坛医院神经内科,北京100050 [2]北京市神经外科研究所神经影像室

出　　处：《中华神经科杂志》2001年第5期280-282,I003,共4页Chinese Journal of Neurology

摘　　要：目的　研究Tolosa Hunt综合征 (THS)的临床表现、影像学检查结果 ,进一步证明其病因为非特异性炎症。方法　回顾总结 1985年 5月至 2 0 0 0年 10月所收治的 2 8例THS住院患者的临床表现、病理及影像学检查结果并结合文献进行病因分析。结果　 2 8例患者头痛形式、部位及程度个体差异较大 ,颅神经受损数量为 1～ 5支 ;复发较常见 ,激素治疗效果明显 ,但可留有颅神经麻痹后遗症。 1例病理结果显示 ,镜下可见病灶内大量淋巴细胞、浆细胞及胶原纤维 ,未见肿瘤细胞 ,病理诊断为炎性肉芽肿。神经影像学检查 :首次CT检查 2 7例 ,6例显示海绵窦区病变 ;MRI检查 2 1例 ,12例显示海绵窦区病变 ;数字减影血管造影术 (DSA)检查 12例 ,5例显示海绵窦区病变。复查时 ,首次CT或MRI阴性的 12例中 4例出现海绵窦区病变 ;首次CT或MRI阳性的 12例中 10例病灶明显减小或基本消失。CT及MRI增强扫描显示病灶表现均匀一致的强化。结论　综合分析临床表现、病理学检查、影像学检查和激素治疗效果 ,进一步证明了THS的病因为非特异性炎症。对影像学表现不典型和激素治疗效果不明显者 ,应定期进行临床和影像学复查 ,有利于提高诊断率和制定治疗方案。Objective To study the clinical manifestation and neuroimaging findings and further to pro ve the etiology of nonspecific inflammation of Tolosa-Hunt syndrome(THS). Methods The clinical manifestation,pathological,neuroimaging a nd pathological data of such 28 cases hospitalized from May 1985 to October 2000 and literatures were retrospectively reviewed. Results The type,the site and t he severity of the headache were shown greatly different individually. The relapse often occurred.The number of the involved cranial nerves varied from 1 to 5 branches.The treatment using corticosteroid was effective but some of th e m were resulting in cranial nerve paralysis. One was operation case in which t h e histologic study showed a number of lymphocytes,plasmocytes and collagenous f ibers,but no tumor cells. Pathological diagnosis showed an inflammatory granu l oma. Neuroimaging examinations: CT scans in 6 of 27 showed cavernous sinus lesi o n (CSL).MRI scans in 12 of 21 cases showed CSL.DSA in 5 of 12 showed CSL. Fol low -up Eexaminations: CT and MRI in 4 of 12 having negative results in the first time examination showed CSL. The CSL both in CT and MRI in 10 of 12 having posi t ive results by the first time examination had obviously diminished or disappeare d. The CSL both in CT and MRI were homogeneously well-enhanced. Co nclusions T he study showed that,the etiology of nonspecific inflammation was supported again . In this article the follow-up study both on clinical and neuroimaging examinat i ons for those atypical and not completely recovered was carried out as to maki ng sure the etiology and further therapy.

关 键 词：痛性眼肌麻痹综合征 海绵窦 病因学 TOLOSA-HUNT综合征 临床特点 影像学研究 诊断标准 

分 类 号：R816.1[医药卫生—放射医学]