Tolosa-Hunt syndrome: one cause of painful ophthalmoplegia

1976 ◽  
Vol 44 (5) ◽  
pp. 544-549 ◽  
Author(s):  
William E. Hunt
Keyword(s):  
Steroid Therapy ◽  
Collagen Disease ◽  
Unknown Etiology ◽  
Steroid Resistant ◽  
Content Type ◽  
Surgical Exploration ◽  
Painful Ophthalmoplegia ◽  
Hunt Syndrome ◽  
Disease Specific ◽  
Fine Print

✓ The author reports 12 cases of Tolosa-Hunt syndrome, a benign steroid-resistant cryptogenic granuloma that presents as painful ophthalmoplegia. This syndrome is differentiated from other causes of painful ophthalmoplegia including tumors, aneurysms, collagen disease, specific infections, mucoceles, and benign granulomas of unknown etiology. These other conditions should be excluded by appropriate tests. Surgical exploration is not necessary if there is a prompt remission on steroid therapy.

Bilateral cavernous sinus actinomycosis resulting in painful ophthalmoplegia

2002 ◽  
Vol 96 (3) ◽  
pp. 600-602 ◽  
Author(s):  
Seiji Ohta ◽  
Shigeru Nishizawa ◽  
Hiroki Namba ◽  
Haruhiko Sugimura
Keyword(s):  
Cavernous Sinus ◽  
Acute Inflammation ◽  
Definitive Diagnosis ◽  
Presumptive Diagnosis ◽  
Content Type ◽  
Surgical Exploration ◽  
Painful Ophthalmoplegia ◽  
Hunt Syndrome ◽  
Penicillin Therapy ◽  
Sulfur Granules

✓ The authors report the successful treatment of a 42-year-old man who suffered from recurrent painful ophthalmoplegia caused by bilateral cavernous sinus (CS) actinomycosis. A presumptive diagnosis of Tolosa—Hunt syndrome was made when he presented with left painful ophthalmoplegia. Recurrent ophthalmoplegia on the opposite side when steroid medications were tapered led to repeated imaging and a pterional craniotomy and biopsy sampling of the CS. These tests demonstrated acute inflammation and sulfur granules, which responded clinically and radiologically to parenterally administered penicillin therapy. Actinomycosis may present as a painful ophthalmoplegia with involvement of one or both CSs. Repeated imaging and possibly surgical exploration may be necessary to make a definitive diagnosis.

Management and results of sciatic nerve injuries: a 24-year experience

1998 ◽  
Vol 89 (1) ◽  
pp. 13-23 ◽  
Author(s):  
David G. Kline ◽  
Daniel Kim ◽  
Rajiv Midha ◽  
Carter Harsh ◽  
Robert Tiel
Keyword(s):  
Sciatic Nerve ◽  
Spontaneous Recovery ◽  
Nerve Injuries ◽  
Management Guidelines ◽  
Content Type ◽  
Surgical Exploration ◽  
Excellent Outcome ◽  
Retrospective Clinical Study ◽  
Late Referral ◽  
Fine Print

Object. The purpose of this retrospective clinical study was to present results and provide management guidelines for various types of sciatic injuries. Methods. Over a 24-year period, 380 patients with sciatic nerve injuries were managed. In 230 patients (60%), the injury was at the buttock level, with injection injuries comprising more than half of these cases. Thigh-level sciatic injury was evaluated in 150 cases (40%) and was usually secondary to one of four main causes: 1) gunshot wound; 2) femur fracture; 3) laceration; or 4) contusion. Patients with partial deficits uncomplicated by severe pain or with significant spontaneous recovery or late referral were managed medically. Surgical exploration was not indicated in 23% of injuries at the thigh level and almost 50% of those at the buttock level. Most of these patients achieved partial but good spontaneous recovery, especially in the tibial division distribution. Surgical intervention was required for more complete and persistent deficits in either the tibial or peroneal distribution. Divisions of the sciatic nerve were split apart and evaluated independently. Management was guided by nerve action potential (NAP) recordings, which indicated whether neurolysis or resection of the lesion was required. Repair was then made by using sutures or more frequently by graft placement. In most cases in which neurolysis was performed because a positive NAP was recorded distal to the lesion, useful function was found in the peroneal distribution. Unfortunately, significant recovery occurred in only 36% of patients who received suture or graft repairs of the peroneal division. Good-to-excellent outcome was common for the tibial division, even in cases in which repair was proximal and required lengthy grafts. The relatively favorable recovery of tibial as opposed to peroneal divisions of the sciatic nerve occurred regardless of the level or mechanism of injury. Conclusions. Surgical exploration and, when necessary, repair of sciatic nerve injuries is worthwhile in selected cases.

Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

1998 ◽  
Vol 88 (2) ◽  
pp. 243-246 ◽  
Author(s):  
Wouter I. Schievink ◽  
Vittorio M. Morreale ◽  
John L. D. Atkinson ◽  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Intracranial Hypotension ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Content Type ◽  
Surgical Exploration ◽  
Fine Print ◽  
Csf Leaks

Object. Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. Methods. Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22–61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. Conclusions. All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3–58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

Dermoid tumors occurring at the site of previous myelomeningocele repair

1986 ◽  
Vol 65 (6) ◽  
pp. 779-783 ◽  
Author(s):  
R. Michael Scott ◽  
Samuel M. Wolpert ◽  
Louis E. Bartoshesky ◽  
Seymour Zimbler ◽  
George T. Klauber
Keyword(s):  
Differential Diagnosis ◽  
Lower Extremity ◽  
Computerized Tomography ◽  
Neurological Deterioration ◽  
Bladder Function ◽  
Content Type ◽  
Surgical Exploration ◽  
Myelomeningocele Repair ◽  
Tomography Scanning ◽  
Fine Print

✓ Four children with previously repaired myelomeningoceles presented toward the end of the first decade or early in the second decade of life with deteriorating lower-extremity and bladder function. Myelography and computerized tomography scanning demonstrated irregular filling defects at the area of the myelomeningocele repair, and surgical exploration disclosed dermoid tumors that were adherent to the placode and adjacent roots. Dermoid tumors should be considered in the differential diagnosis of neurological deterioration in children with a repaired myelomeningocele.

Treatment of moyamoya disease with STA-MCA anastomosis

1978 ◽  
Vol 49 (5) ◽  
pp. 679-688 ◽  
Author(s):  
Jun Karasawa ◽  
Haruhiko Kikuchi ◽  
Seiji Furuse ◽  
Junichiro Kawamura ◽  
Toshisuke Sakaki
Keyword(s):  
Cerebrovascular Disease ◽  
Effective Treatment ◽  
Moyamoya Disease ◽  
Neurological Deficits ◽  
Unknown Etiology ◽  
Transient Ischemic Attacks ◽  
Content Type ◽  
Fine Print ◽  
Temporal Middle

✓ Moyamoya disease is a chronic occlusive cerebrovascular disease of unknown etiology for which no effective treatment has been found. The authors report the results of 23 superficial temporal-middle cerebral artery (STA-MCA) anastomoses and seven encephalomyosynangioses, performed on 13 cases with moyamoya disease and on four additional atypical cases. There were 10 children and seven adults in this study. The follow-up period ranged from 1 year and 4 months to 4 years and 1 month postoperatively; nine patients had excellent results, five good, and one fair; two patients were unchanged. The anastomotic procedure was most effective for transient ischemic attacks, reversible ischemic neurological deficits, and even minor or moderate neurological symptoms. The STA-MCA anastomosis appears to be an effective treatment for moyamoya disease.

Steroid-induced remission in spinal canal reticulum cell sarcoma

1975 ◽  
Vol 42 (3) ◽  
pp. 346-348 ◽  
Author(s):  
Patrick R. R. Clarke ◽  
Michael Saunders
Keyword(s):  
Steroid Therapy ◽  
Spinal Canal ◽  
Guillain Barre Syndrome ◽  
Reticulum Cell ◽  
Reticulum Cell Sarcoma ◽  
Case Histories ◽  
Content Type ◽  
Cell Sarcoma ◽  
Guillain Barré ◽  
Fine Print

✓ The authors record the case histories of two patients originally diagnosed as having the Guillain-Barré syndrome, who responded to steroid therapy and were subsequently shown to have reticulum cell sarcomas. The dangers of attaching significance to steroid-induced remissions are stressed.

The angiographically occult cerebrovascular malformation

1978 ◽  
Vol 48 (2) ◽  
pp. 292-296 ◽  
Author(s):  
James B. Golden ◽  
Richard A. Kramer
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Vascular Malformation ◽  
Ct Scans ◽  
Cerebral Lesions ◽  
Content Type ◽  
Surgical Exploration ◽  
Diagnostic Possibility ◽  
Cerebrovascular Malformation ◽  
Fine Print

✓ Three cases presenting with hemiparesis, headache, or seizures gave no history suggestive of subarachnoid or intracerebral hemorrhage. Carotid arteriograms were performed, and in each case failed to demonstrate a vascular malformation. In all three cases cerebral lesions were shown by either computerized tomographic (CT) scan, radionuclide scan, or both. Surgical exploration and biopsy revealed a vascular malformation in each case. The CT scans in two of the cases showed dense lesions that could suggest vascular malformation as a diagnostic possibility.

The prognosis in subarachnoid hemorrhage of unknown etiology

1984 ◽  
Vol 61 (6) ◽  
pp. 1029-1031 ◽  
Author(s):  
Vagn Eskesen ◽  
Ebbe B. Sørensen ◽  
Jarl Rosenørn ◽  
Kaare Schmidt
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Functional Capacity ◽  
Unknown Etiology ◽  
Vertebral Angiography ◽  
Content Type ◽  
Moderate Reduction ◽  
Bilateral Carotid ◽  
Fine Print

✓ The mortality rate, risk of rebleeding, relevant subjective and objective symptoms, and daily functional capacity after a verified subarachnoid hemorrhage (SAH) of unknown etiology were evaluated in 44 patients treated during a 5-year period (1978 to 1983). A vascular basis for the SAH had been excluded by bilateral carotid and vertebral angiography and computerized tomography. The patients were interviewed at a follow-up examination from 3 to 64 months (median 36 months) after the bleed. The results revealed a 5% mortality rate and a 7% risk of rebleeding. Persisting headache and fatigue were found in 40% of patients, 29% had mild demential symptoms, and 5% had persisting and severe objective neurological symptoms. None had developed epilepsy. A normal daily functional capacity was enjoyed by 84%, while 14% had a moderate reduction in these functions, but were independent of help from other persons. One patient (2%) was not fully assessed.

Postirradiation necrosis of the temporal lobe presenting as a glioma

1976 ◽  
Vol 44 (6) ◽  
pp. 732-734 ◽  
Author(s):  
J. Victor Diengdoh ◽  
Anthony E. Booth
Keyword(s):  
Parotid Gland ◽  
Temporal Lobe ◽  
Microscopic Examination ◽  
Radiation Necrosis ◽  
Left Temporal Lobe ◽  
Content Type ◽  
Surgical Exploration ◽  
Left Parotid Gland ◽  
Space Occupying Lesion ◽  
Fine Print

✓ A patient is reported who presented with manifestations of a space-occupying lesion in the left temporal lobe thought to be a metastasis, but on radiological examination and surgical exploration appeared to be a diffuse infiltrative glioma. Some 21 months earlier he had received a course of fast neutron therapy to a carcinoma of the left parotid gland. Diagnosis by microscopic examination revealed changes characteristic of delayed radiation necrosis.

Bitemporal hemianopsia associated with sclerosis of the intracranial internal carotid arteries

1980 ◽  
Vol 53 (4) ◽  
pp. 566-569 ◽  
Author(s):  
Koichi Matsuo ◽  
Shigeaki Kobayashi ◽  
Kenichiro Sugita
Keyword(s):  
Carotid Arteries ◽  
Internal Carotid ◽  
Visual Fields ◽  
Optic Nerves ◽  
Content Type ◽  
Surgical Exploration ◽  
Microsurgical Decompression ◽  
Internal Carotid Arteries ◽  
Fine Print

✓ A case of bitemporal hemianopsia in a 68-year-old woman is reported. Surgical exploration revealed bilateral compression of the optic nerves by the arteriosclerotic internal carotid arteries. Microsurgical decompression with unroofing of the optic canals resulted in prompt recovery of the visual fields.

Sign in / Sign up

Export Citation Format

Share Document