Tolosa–Hunt syndrome misdiagnosed as sinusitis complication

2008 ◽  
Vol 122 (1) ◽  
pp. 97-99 ◽  
Author(s):  
V A Lachanas ◽  
G T Karatzias ◽  
I Tsitiridis ◽  
I Panaras ◽  
V G Sandris
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cavernous Sinus ◽  
Motor Nerve ◽  
Granulomatous Inflammation ◽  
Resonance Imaging ◽  
Hunt Syndrome ◽  
Computed Tomography Scanning ◽  
Orbital Complication

AbstractObjective:Tolosa–Hunt syndrome is a rare condition of painful ophthalmoplegia combined with ipsilateral ocular motor nerve palsies, caused by non-specific granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. A case of Tolosa–Hunt syndrome misdiagnosed as sinusitis orbital complication is reported.Case report:A patient suffering from left periorbital pain, upper eyelid oedema and ptosis, and horizontal diplopia, diagnosed as sinusitis orbital complication, was referred to our department. Clinical evaluation revealed only a left VIth nerve paresis. Haematological studies, cerebrospinal fluid tests and computed tomography scanning were negative. A magnetic resonance imaging (MRI) scan showed enhancement of the left cavernous sinus. Corticosteroid therapy was commenced, and within three days all symptoms disappeared. A diagnosis of Tolosa–Hunt syndrome was made. Follow-up MRI studies were normal.Conclusion:Tolosa–Hunt syndrome, although rare, is a nosological entity that otolaryngologists must bear in mind. Magnetic resonance imaging studies are essential in the diagnosis and follow up of these patients, in order to avoid a mistaken Tolosa–Hunt syndrome diagnosis.

scholarly journals A 17-Year-Old Girl With Unilateral Headache and Double Vision

2019 ◽  
Vol 7 ◽  
pp. 232470961983830
Author(s):  
Larissa G. Rodriguez-Homs ◽  
Mark Goerlitz-Jessen ◽  
Samrat U. Das
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Cranial Nerves ◽  
Granulomatous Inflammation ◽  
Vascular Lesions ◽  
Resonance Imaging ◽  
Painful Ophthalmoplegia ◽  
Hunt Syndrome

Tolosa-Hunt syndrome is characterized by a painful ophthalmoplegia secondary to a granulomatous inflammation in or adjacent to the cavernous sinus. Magnetic resonance imaging will show enhancement of the cavernous sinus and/or the orbital apex. Although this syndrome is extremely rare in children, it should be a diagnostic consideration in patients presenting with painful ophthalmoplegia with variable involvement of cranial nerves II to VI. The differential diagnosis for unilateral cavernous sinus lesion is broad, including vascular lesions (cavernous sinus thrombosis), inflammatory processes (sarcoidosis, autoimmune), neoplastic processes (schwannoma, lymphoma), as well as infectious etiologies. We describe a pediatric patient presenting with neurological symptoms from a unilateral cavernous sinus magnetic resonance imaging abnormality and the thorough diagnostic approach to arrive at the diagnosis of Tolosa-Hunt syndrome.

The Value of Enhanced Three-dimensional Brain volume magnetic Resonance Imaging in tolosa-hunt Syndrome: A Clinical Retrospective Study

2020 ◽  
Author(s):  
Guoliang Lin ◽  
Shushu Zhang ◽  
Beilei Hu ◽  
Songfang Chen ◽  
Ming Zou ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cavernous Sinus ◽  
Brain Volume ◽  
Three Dimensional ◽  
Resonance Imaging ◽  
High Detection Rate ◽  
Negative Results ◽  
Hunt Syndrome ◽  
Conventional Mri

Abstract Background: The study aimed to evaluate the enhanced three-dimensional brain volume magnetic resonance imaging (3D-BRAVO) in the diagnosis of Tolosa-Hunt syndrome (THS). Methods: we described 21 patients with THS and their case records including clinical syndromes and neuroradiologic features by conventional MRI and enhanced 3D-BRAVO. Results: 19 patients showed enhancement in the cavernous sinus through 3D-BRAVO. 16/19had ipsilateral enhanced lesions involved 4-10 continuous slices in cavernous sinus on 3D-BRAVOscan. Both local size enlargements and enhancement in the cavernous sinus were found in 3 patients. The rest 2 patients performed negative results on neither conventional MRI nor enhanced 3D-BRAVO. Conclusions: enhanced 3D-BRAVO imaging demonstrated a high detection rate in the cavernous sinus, which may promote our understanding ofTolosa-Hunt syndrome.

Gamma Knife Surgery for Cavernous Hemangiomas in the Cavernous Sinus

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 611-616 ◽  
Author(s):  
Chiang-Wei Chou ◽  
Hsiu-Mei Wu ◽  
Chun-I Huang ◽  
Wen-Yuh Chung ◽  
Wan-Yuo Guo ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Tumor Volume ◽  
Gamma Knife Surgery ◽  
Volume Reduction ◽  
Resonance Imaging ◽  
Tumor Volume Reduction

Abstract BACKGROUND Cavernous hemangioma in the cavernous sinus (CS) is a rare vascular tumor. Direct microsurgical approach usually results in massive hemorrhage. Radiosurgery has emerged as a treatment alternative to microsurgery. OBJECTIVE To further investigate the role of Gamma Knife surgery (GKS) in treating CS hemangiomas. METHODS This was a retrospective analysis of 7 patients with CS hemangiomas treated by GKS between 1993 and 2008. Data from 84 CS meningiomas treated during the same period were also analyzed for comparison. The patients underwent follow-up magnetic resonance imaging at 6-month intervals. Data on clinical and imaging changes after radiosurgery were analyzed. RESULTS Six months after GKS, magnetic resonance imaging revealed an average of 72% tumor volume reduction (range, 56%–83%). After 1 year, tumor volume decreased 80% (range, 69%–90%) compared with the pre-GKS volume. Three patients had > 5 years of follow-up, which showed the tumor volume further decreased by 90% of the original size. The average tumor volume reduction was 82%. In contrast, tumor volume reduction of the 84 cavernous sinus meningiomas after GKS was only 29% (P < .001 by Mann-Whitney U test). Before treatment, 6 patients had various degrees of ophthalmoplegia. After GKS, 5 improved markedly within 6 months. Two patients who suffered from poor vision improved after radiosurgery. CONCLUSION GKS is an effective and safe treatment modality for CS hemangiomas with long-term treatment effect. Considering the high risks involved in microsurgery, GKS may serve as the primary treatment choice for CS hemangiomas.

Ewing's Sarcoma of the Cavernous Sinus: Case Report

Neurosurgery ◽  
2005 ◽  
Vol 56 (6) ◽  
pp. E1375-E1375 ◽  
Author(s):  
Medina Kushen ◽  
H Evin Gulbahce ◽  
Cornelius H. Lam
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cavernous Sinus ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Resonance Imaging ◽  
Unusual Site ◽  
Long Term Follow Up

Abstract OBJECTIVE AND IMPORTANCE: The Ewing's sarcoma (ES) family of tumors is a relatively rare entity, presenting most commonly in children. While the most common sites for this group of tumors are the trunk and the extremities, this case is unique in that we describe a long-term follow-up with an ES presenting in the cavernous sinus. CLINICAL PRESENTATION: We report the case of a 13-year-old girl presenting with the symptoms of classic orbital apex syndrome. Magnetic resonance imaging disclosed a cavernous sinus mass engulfing the optic nerve and extending into the superior orbital fissure. INTERVENTION: Evaluation of this patient included intracranial magnetic resonance imaging angiography and biopsy of the cavernous sinus mass lesion. Histopathological findings yielded a diagnosis of ES. Further work-up demonstrated that the patient's thyroid was also involved. The tumor was treated with radiation therapy to both sites and, subsequently, after confirmed metastases to other sites, 11 cycles of doxorubicin-based chemotherapy, as well as bone marrow transplantation. However, the patient succumbed to the illness 18 months after her initial diagnosis. CONCLUSION: The cavernous sinus is an unusual site for ES, but given the vascularity and the frequency of this tumor in childhood, the diagnosis should be entertained. This patient with an ES of cavernous sinus may be the first reported case with a long-term follow-up in the literature.

Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1081-1089 ◽  
Author(s):  
John Sinclair ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
John R. Adler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

Magnetic Resonance Imaging T2* Mapping of the Talar Dome and Subtalar Joint Cartilage 3 Years After Anterior Talofibular Ligament Repair or Reconstruction in Chronic Lateral Ankle Instability

2021 ◽  
Vol 49 (3) ◽  
pp. 737-746
Author(s):  
Yiwen Hu ◽  
Yuyang Zhang ◽  
Qianru Li ◽  
Yuxue Xie ◽  
Rong Lu ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Resonance Imaging ◽  
Talar Dome ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability

Background: Cartilage degeneration is a common issue in patients with chronic lateral ankle instability. However, there are limited studies regarding the effectiveness of lateral ligament surgery on preventing talar and subtalar joint cartilage from further degenerative changes. Purpose: To longitudinally evaluate talar and subtalar cartilage compositional changes using magnetic resonance imaging T2* mapping in anatomic anterior talofibular ligament (ATFL)–repaired and ATFL-reconstructed ankles and to compare them with measures in asymptomatic controls. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2015 and December 2016, patients with chronic lateral ankle instability who underwent anatomic ATFL repair (n = 19) and reconstruction (n = 20) were prospectively recruited. Patients underwent 3.0-T magnetic resonance imaging at baseline and 3-year follow-up. As asymptomatic controls, 21 healthy volunteers were recruited and underwent imaging at baseline. Talar dome cartilage was divided into (1) medial anterior, central, and posterior and (2) lateral anterior, central, and posterior. Posterior subtalar cartilage was divided into (1) central talus and calcaneus and (2) lateral talus and calcaneus. Ankle function was assessed using the American Orthopaedic Foot & Ankle Society scores. Results: There were significant increases in T2* values in medial and lateral posterior and central talus cartilage from baseline to 3-year follow-up in patients who underwent repair. T2* values were significantly higher in ATFL-repaired ankles at follow-up for all cartilage regions of interest, except medial and lateral anterior and lateral central, compared with those in healthy controls. From baseline to 3-year follow-up, ATFL-reconstructed ankles had a significant increase in T2* values in lateral central and posterior cartilage. T2* values in ATFL-reconstructed ankles at follow-up were elevated in all cartilage regions of interest, except medial and lateral anterior, compared with those in healthy controls. ATFL-repaired ankles showed a greater decrease of T2* values from baseline to follow-up in lateral calcaneus cartilage than did ATFL-reconstructed ankles ( P = .031). No significant differences in American Orthopaedic Foot & Ankle Society score were found between repair and reconstruction procedures (mean ± SD, 19.11 ± 7.45 vs 16.85 ± 6.24; P = .311). Conclusion: Neither anatomic ATFL repair nor reconstruction could prevent the progression of talar dome and posterior subtalar cartilage degeneration; however, ankle function and activity levels were not affected over a short period. Patients who underwent ATFL repair exhibited lower T2* values in the lateral calcaneus cartilage than did those who underwent reconstruction.

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