Retrospective Study Of The Diagnosis On Painful Ophthalmoplegia

Objective：In order to improve the quality of diagnosis and treatment on Tolosa-Hunt Syndrome (THS), the data of inatients with PO in the department of Neurology and Ophthalmology were retrospectively analyzed using the criteria of the International Classification of Headache Disorders (ICHD).Methods：We conducted a search for the data of inpatients with chief complaint of headache and ophthalmoplegia in the department of Neurology and Ophthalmology of First Affiliated Hospital of Fujian Medical University from July2009to April2014. Respectively compairing the discharge diagnosis of those patients we collected， especially Tolosa Hunt syndrome (THS), with the diagnostic criteria of the ICHD-2and ICHD-3beta version, the results were analyzed.A total of145patients with chief complaint of headache and ophthalmoplegia were included in this study. Of which83males, mean age52.8±15.3years;62females, mean age51.3±16.8years old. There are117cases in the Department of Neurology, while28cases from ophthalmology.Results：A total of92patients with PO were screened out in this study. In addition to those with diagnosis of cancer, diabetic, aneurysma, migraine and other definitive disorders, there were only two cases with discharge diagnosis as THS, and29cases as PO. In the92cases, according to the ICHD-2diagnostic standards, there were33cases could be diagnosed as THS，including25cases who were definitely accorded with the criteria of THS, and8cases who were suspected of THS. Of the33cases with THS,66.6%of them was misdiagnosed as PO,18.2%was misdiagnosed as meningitis,9.1%was misdiagnosed as cavernous sinus syndrome. According to the ICHD-3diagnostic standards,10/33cases could be diagnosed as THS, of which8cases were diagnosed with THS definitely, and2cases were suspected of THS. Of the33cases with THS,20%was misdiagnosed as PO,60%was misdiagnosed as meningitis,10%was misdiagnosed as cavernous sinus syndrome. The ratio of correct discharge diagnosis as THS (including suspected people) compliance with ICHD-2and ICHD-3respectively was6.1%, and10%. Diagnosis according to ICHD-2 criteria, in the patients with THS, the largest number of cranial nerve palsy was oculomotor, then second was outreach nerve, and third was trigeminal nerve. Both of trochlear and optic nerve were least. According to ICHD-3criteria,, the largest number of cranial nerve palsy was outreach nerve, then second was oculomotor, third was trigeminal nerve, fourth was optic nerve. There was not trochlear nerve palsy. There were palsy of second branch of the trigeminal nerve and optic nerve in patients with THS, it is rare seen. The ratio of the cases definiting diagnosis of THS with MRI evidence in ICHD-2THS was8/25(32.0%), with a maximum of cavernous sinus involvement, and in ICHD-3THS was8/8(100.0%), also with a maximum of cavernous sinus involvement. In both groups of patients diagnosed with ICHD-2or ICHD-3，the remission rates of ophthalmoplegia within72hours were low, but the rates of headache relief were high.Conclusion：There was a high rate of misdiagnosis in discharge diagnosis on THS. The promotion and application of ICHD-3should be enhanced in clinical practice. ICHD-3is more stringent than ICHD-2. The role of MRI and pathologic evidence in the criteria has been strengthened in the ICHD-3, and the diagnostic role of therapeutic response to steroid treatment has been downgraded. Our results of this survey support to weaken the effect of hormone therapy in the diagnostic criteria. The application of ICHD-3will reduce the rate of misdiagnosis on THS. The key of Tolosa-Hunt syndrome diagnosis is to follow the latest diagnostic criteria, complete the medical history of headache and muscle paralysis and other relevant, take necessary auxiliary examination and follow-up.