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      Síndrome de Tolosa-Hunt Translated title: Tolosa-Hunt syndrome

      case-report

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          Abstract

          RESUMO A Síndrome de Tolosa Hunt é uma doença rara, cuja etiopatogenia é desconhecida. Apresenta-se como uma oftalmoplegia dolorosa de um ou mais nervos cranianos oculomotores, que regride espontaneamente e responde bem ao tratamento com corticoides. O presente estudo trata-se de um relato de caso de um paciente que apresentou seguidos casos de oftalmoplegias dolorosas, envolvendo o nervo oculomotor e o abducente sendo tratado com corticoesteroides obteve uma resposta dramática. Objetiva-se ainda descrever as características fisiopatológicas, clínicas, o diagnóstico diferencial, visto que é um diagnóstico de exclusão, e medidas terapêuticas instituídas de acordo com o International Headache Society 2004 (ISH-2004) através da apresentação do caso clínico conduzido com as normas do estudo supracitado.

          Translated abstract

          ABSTRACT Tolosa Hunt syndrome is a rare disease, whose etiology is unknown. It presents as a painful ophthalmoplegia of one or more oculomotor cranial nerves, which resolves spontaneously and responds well to treatment with corticosteroids. This study is a case report of a patient who had followed painful oftalmoplegias cases involving the oculomotor and abdcens nerves being treated with corticosteroids, obtaining a dramatic response. Another goal is to describe the pathophysiological, clinical, differential diagnosis, since it is a diagnosis of exclusion, and the therapeutic measures adopted according to the International Headache Society 2004 (ISH-2004) by presenting the case study conducted with the standards the study cited above.

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          Most cited references6

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          The Tolosa-Hunt syndrome.

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            Periarteritic lesions of the carotid siphon with the clinical features of a carotid infraclinoidal aneurysm.

            E Tolosa (1954)
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              Tolosa-Hunt syndrome: critical literature review based on IHS 2004 criteria.

              In 2004, the International Headache Society (IHS) re-defined the diagnostic criteria of Tolosa-Hunt syndrome (THS) specifying that granuloma, demonstrated by magnetic resonance imaging (MRI) or biopsy, is required for diagnosis. We reviewed the literature on THS published from 1988 (year of publication of first IHS criteria) to 2002, analysing individual cases in relation to the new IHS criteria. One hundred and twenty-four cases were identified. As far as it was possible to discern, clinical presentation was similar in all, but 44 (35%) were reported to have inflammation on MRI or bioptic evidence of granuloma, 41/124 (33%) had normal neuroimaging findings and 39 (31%) had a specific lesion, so the THS was secondary. These data confirm that clinical criteria for THS are common to several conditions and their application alone does not guarantee a correct diagnosis. The requirement for inflammation on MRI will result in better classification of painful ophthalmoplegias; nevertheless, an MRI protocol that best defines inflammation should be specified. The status of cases which fulfil the clinical criteria but have normal MRI remains to be clarified.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbof
                Revista Brasileira de Oftalmologia
                Rev. bras.oftalmol.
                Sociedade Brasileira de Oftalmologia (Rio de Janeiro )
                1982-8551
                February 2016
                : 75
                : 1
                : 64-66
                Affiliations
                [1 ] Hospital Municipal da Piedade Brazil
                [2 ] Universidade Gama Filho Brazil
                [3 ] Hospital Universitário Clementino Fraga Filho Brazil
                Article
                S0034-72802016000100064
                10.5935/0034-7280.20160015
                263b508a-72cf-40ad-9da6-b5d00303da4f

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0034-7280&lng=en
                Categories
                OPHTHALMOLOGY

                Ophthalmology & Optometry
                Tolosa-Hunt syndrome/diagnosis,Ophthalmoplegia/drug therapy,Prednisone/therapeutic use,Pain/classification,International Classification of Diseases,Case reports,Síndrome de Tolosa-Hunt/diagnóstico,Oftalmoplegia/quimioterapia,Prednisona/uso terapêutico,Dor/classificação,Classificação Internacional de Doenças,Relato de casos

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