Tolosa-Hunt综合征临床及影像学分析  

Study on the clinical manifestation and imaging examination of Tolosa-Hunt syndrome

作　　者：胡珏[1] 赵志鸿[2] 周俊杰[3] 

机构地区：[1]长沙市中心医院神经内科,湖南长沙410004 [2]湖南省人民医院神经内科,湖南长沙410005 [3]长沙市中心医院放射科,湖南长沙410004

出　　处：《中风与神经疾病杂志》2015年第7期623-626,共4页Journal of Apoplexy and Nervous Diseases

基　　金：湖南省科技厅资助项目(No.2013FJ3119)

摘　　要：目的探讨Tolosa-Hunt综合征（THS）的临床、影像学表现及治疗，提高对该病的诊治水平。方法对12例THS患者的临床表现、实验室检查、神经影像学结果、治疗方法及转归进行回顾性分析。结果12例患者多为亚急性起病，2例眼肌麻痹与头痛同时发生、10例在头痛后14d内出现；9例动眼神经麻痹、6例外展神经麻痹、2例滑车神经麻痹、2例视神经受累；血常规、血沉、脑脊液压力、常规、生化检查基本正常；MRI检查显示12例患侧海绵窦区软组织增厚、4例患侧眶上裂软组织增厚，病灶呈均匀性强化。所有患者激素治疗后10～72h内疼痛缓解，11例用药后4～60（29．7±18．0）d体征完全恢复，1例遗留脑神经麻痹。结论THS的头痛可先于眼肌麻痹2W或同时发生，血常规、血沉和脑脊液检查对诊断缺乏特异性提示，海绵窦MRI对诊断有重要价值，激素治疗效果明显，但体征恢复比疼痛缓解需要更长时间。Objective To study the clinical manifestation, imaging examination and treatment of Tolosa-Hunt syn- drome in order to improve the diagnosis and treatment level in clinical practice. Methods The clinical manifestation, labo- ratory examination, treatment and prognosis datas of twelve cases with Tolosa-Hunt syndrome were retrospectively reviewed. Results Most of the cases were onset subacutely. Paresis coincided with the onset of pain in two cases. Paresis followed the onset of pain within 14 d in ten cases. Nine eases developed oculomotor paralysis. Six cases developed abducens nerve paralysis. Two cases developed trochlear nerve paralysis. Two cases had involvement of optic nerve. Blood routine, blood sedimentation, cerebrospinal fluid pressure and routine and biochemical analysis were almost normal. MRI showed the in- crease in the size of the cavernous sinus due to abnormal soft tissuee ]esion in 12 eases and the abnormal soft tissuce lesion extended to superior orbital fissure in 4 eases. The lesion showed marked enhancement after intravenous gadolinium. All eases had good response to corticosteroid therapy. Pain were relieved within 10-72 hours after initiation of corticosteroid therapy. Signs were resoloved within 4 - 60 d after initiation of cortieosteroid therapy in 11 cases. Sequela of cranial nerve paralysis was found in one ease. Conclusion Paresis may coincides with the onset of pain or follows it within 14 d in eases with Tolosa-Hunt syndrome. The laboratory exam/nation were was lack of specific suggestion for diagnose. MRI of cavernous sinus plays a pivotal role to diagnose. The condition is exquisitely sensitive to eorticosteroid therapy. The time to reach signs resolution is longer than pain resolution.

关 键 词：TOLOSA-HUNT综合征 海绵窦 磁共振成像 

分 类 号：R745.1[医药卫生—神经病学与精神病学]