title: A comparison of benign and inflammatory manifestations of Tolosa-Hunt syndrome.
abstract: BACKGROUND
  Tolosa-Hunt syndrome (THS) manifests as a benign or an inflammatory type disease. The nosography differences between these types remain to be elucidated. We aimed to analyze and compare the clinical presentations of benign and inflammatory THS.
  
  
  METHODS
  The ward patients who presented with THS from January 1990 to May 2011 were retrospectively reviewed. THS was diagnosed according to the recommendations of the International Headache Society.
  
  
  RESULTS
  Of the 53 THS cases (49 patients), 30 (56.6%) were classified as benign and 23 (43.4%) as inflammatory THS. There were strong similarities between the groups in terms of clinical manifestations, laboratory findings, responses to glucocorticoid treatment, and outcomes. However, patients with inflammatory THS tended to be younger (mean age, 43.4 years; P 0.05) and have optic nerve dysfunction (56.5%; P 0.05) and longer disease duration (2.3 ± 1.0 months; P 0.05) compared to those with benign THS (mean age, 56.4 years; mean disease duration, 1.6 ± 0.7 months). The patients with additional involvement of both the optic nerve and the second division of the trigeminal nerve experienced a longer disease duration ( P 0.05). Additionally, patients with orbital pseudotumors had diplopia that responded poorly to treatment with glucocorticoids ( P 0.05). High-dose (>0.5 mg/kg/day) and low-dose (≤0.5 mg/kg/day) prednisolone were equally effective in relieving symptoms in both groups ( P > 0.05).
  
  
  CONCLUSIONS
  Benign and inflammatory THS were highly similar in terms of nosography. The responses to glucocorticoid treatment were generally good except in patients with orbital pseudotumors.
authors.affiliation: Department of Neurology, E-Da Hospital, I-Shou University, Taiwan.
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Hung
authors.forename: Kuo-Hsuan
authors.initials: KH
authors.lastname: Chang
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Wu
authors.forename: Yao-Liang
authors.initials: YL
authors.lastname: Chen
authors.forename: Rong-Kuo
authors.initials: RK
authors.lastname: Lyu
authors.forename: Hong-Shiu
authors.initials: HS
authors.lastname: Chang
authors.forename: Yih-Ru
authors.initials: YR
authors.lastname: Wu
authors.forename: Chiung-Mei
authors.initials: CM
authors.lastname: Chen
authors.forename: Chin-Chang
authors.initials: CC
authors.lastname: Huang
authors.forename: Chun-Che
authors.initials: CC
authors.lastname: Chu
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Liao
authors.forename: Yau-Yau
authors.initials: YY
authors.lastname: Wai
authors.forename: Shih-Pin
authors.initials: SP
authors.lastname: Hsu
authors.forename: Long-Sun
authors.initials: LS
authors.lastname: Ro
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D012189:Retrospective Studies; D020333:Tolosa-Hunt Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D020433:Trigeminal Nerve Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology
keywords: Painful ophthalmoplegia; Tolosa-Hunt syndrome; cavernous sinus; glucocorticoid treatment; magnetic resonance imaging