Clinical Analysis Of 1 Case Of Children With Painful Ophthalmoplegia Syndrome And Review Of The Literature

Objective: To analyze the clinical characteristics and diagnosis and treatment of painful ophthalmoplegia syndrome in children and improve pediatricians' diagnosis and treatment of THS.Methods: The history,clinical manifestation,auxiliary examination,diagnosis and treatment of a child with Tolosa-Hunt syndrome were analyzed in detail,and the related literatures were reviewed.Results: The 12-year-old male was hospitalized for 4 months of intermittent headache and 3 days of deviation of the mouth and the left eye.The headache was seen in the left side,the left orbit was slightly painful,the left eye fissure was small,the left eyelid was closed incompletely,the left nasal and labial sulcus became shallow,and the angle of mouth was tilted to the right.After 3 days of treatment,the left eye vision decreased,and then the eyeball movement was limited,especially the abduction limitation.The results of brain MRI+ DWI+ enhancedMRI+ MRA showed that the left cavernous sinus was slightly larger,the left orbital apex and left orbital fat signal was abnormal,and the left cerebellum dura mater was thickened.Ophthalmology comprehensive examinations and visual evoked potential,head and neck lymph node,brain DSA did not see obvious abnormality.The child was hospitalized in 4 hospitals and eventually diagnosed as painful ophthalmoplegia syndrome.He was treated glucocorticoid,then he was discharged from hospital and continuing to take glucocorticoid outside hospital.After 4 weeks of follow-up,there was no obvious abnormality in MRI,and the glucocorticoid decreased gradually(the total course of treatment of glucocorticoid was about 12 weeks).There was no obvious abnormality in MRI and no obvious clinical symptoms after stopping taking medicine for 2 months and 3 months.After 7 months of withdrawal,no clinical symptoms were found in the telephone follow-up.Conclusion:1 The incidence of Tolosa-Hunt syndrome in children is low,and the gold standard for diagnosis is pathological biopsy.However,due to the special location of the disease and the compliance factors of the patients,there are very few conditions for pathological biopsy at present.The key to diagnosis lies in the flexible application of the latest diagnostic criteria of ICHD-3,the improvement of relevant medical history data,the auxiliary examination,the detection of other causes of headache and ophthalmoplegia at the same time,and the active follow-up observation.2 Tolosa-Hunt syndrome in children is difficult to diagnose,misdiagnosed and missed diagnosis rate is high.Attention should be paid to distinguish from other painful ophthalmoplegia diseases such as ophthalmoplegia migraine,hemangioma,tumor,infectious disease and so on.3 The treatment of Tolosa-Hunt syndrome with glucocorticoid is effective.The treatment follows the principle of individualization,early,adequate,full course of treatment and gradual decrement.4 The prognosis of Tolosa-Hunt syndrome is good,but it is easy to recur.Glucocorticoid therapy is still effective after recurrence.