Clinical Approach to Painful Ophthalmoplegia: Literature Review in the Light of Case Examples
Derya Uludüz1, Ayşegül Gündüz1, Sait Albayram2, Sabahattin Saip1, Aksel Siva1
1Department Of Neurology, İstanbul University, Cerrahpasa Faculty Of Medicine, İstanbul, Turkey
2Neuroradiology Unit, Department Of Radiology, İstanbul University, Cerrahpasa Faculty Of Medicine, İstanbul, Turkey
Keywords: Painful ophthalmoplegia, differential diagnosis
Abstract
Scientific background and OBJECTIVE: Painful ophtalmoplegia is one of the important disorders that results in admissions to emergency department, neurologists and ophthalmologists. It comprises periorbital and/or frontotemporal severe pain, ipsilateral oculomotor nerve palsies, Horner syndrome and involvement of trigeminal nerve ophtalmic division. Various etiological factors affecting brain stem, cavernous sinus, superior orbital fissure, retroorbital fossa or all of them may result in painful ophtalmoplegia.
MATERIALS-METHODS: We aim to present clinical, radiological and laboratory findings of 18 patients admittted to headache out-patient clinic of our department in last 2 years and review the literature. All cases underwent detailed neurological examination and radiological and extensive laboratory investigations and we performed lumbar puncture when needed.
RESULTS: There were 10 female and 8 male patients. Clinical features and radiological and laboratory findings revealed Tolosa-Hunt syndrome in 7 cases, pseudo-tumor orbit in 1, pachymenengitis in 1, thyroid ophtalmopathy in 2, diabetic neuropathy in 1, carotico-cavernous fistula in 1, metastatic tumor in 2, aneurysm in 1, ophthalmoplegic migraine in 1 and intracranial hypotension in 1.
CONCLUSION: Various etiological factors may underlie patients admitted with painful ophtalmoplegia, therefore cranial magnetic resonance imaging with gadolinium as well as lumbar puncture and biopsy when needed may have to be performed for differential diagnosis.