How to differentiate painful ophthalmoplegia?

summary

Painful ophthalmoplegia, also known as painful ophthalmoplegia, painful ophthalmoplegia syndrome, Tolosa Hunt syndrome, is a non-specific chronic inflammation of cavernous sinus and its vicinity, characterized by retrobulbar pain and ophthalmoplegia. How to differentiate painful ophthalmoplegia?

How to differentiate painful ophthalmoplegia?

Internal carotid artery aneurysms located near the cavernous sinus can cause unilateral damage of the third, fourth, sixth cranial nerve and the first branch of the fifth cranial nerve, resulting in exophthalmos, conjunctival edema and ophthalmoplegia after migraine. The most common manifestation was subarachnoid hemorrhage, and aneurysmal hemorrhage accounted for 80% - 91.3%, so cerebrospinal fluid was bloody. Cerebral arteriography can show that it is not difficult to make a differential diagnosis

Ophthalmoplegic migraine migraine occurs before ophthalmoplegia. The pain is located at the top of the forehead or frontal orbit. It is paroxysmal pulsatile pain or throbbing pain, not persistent acupuncture like or tearing like pain. Ophthalmoplegia is more common in the third cranial nerve damage, rarely involving other cranial nerves. Cerebral arteriography was negative.

Pathologically, orbital inflammatory pseudotumor is a kind of nonspecific granuloma, similar to Tolosa Hunt syndrome. The main clinical manifestation of orbital inflammatory pseudotumor is exophthalmos. The nature of pain is dull pain. The orbital region can touch hard mass or cord mass, accompanied by eyelid and conjunctival edema. About 1 / 3 of the patients were bilateral. B ultrasound examination showed orbital mass shadow and extraocular muscle hypertrophy.

matters needing attention

Carotid cavernous fistula is characterized by exophthalmos, pulsation of eyeball and intracranial murmur. It may be accompanied by ophthalmoplegia, conjunctival congestion and edema, visual impairment, headache and distending pain. Most patients have a history of head trauma, and can be identified by carotid angiography. The prognosis of visual acuity is poor because of inflammation. The key lies in the early treatment, and looking for pathogenic factors, in the treatment of eye disease at the same time the treatment of systemic disease. Acute period should pay attention to rest. It is better to carry out laser treatment when neovascularization is found by fundus fluorescein angiography. Through comprehensive measures to promote the absorption of exudation and bleeding, some cases can also recover good vision due to early treatment. Pay attention to strengthen physique, prevent facial and upper respiratory tract infection.