Validation of ICHD-3 beta diagnostic criteria for 13.7 Tolosa-Hunt syndrome: Analysis of 77 cases of painful ophthalmoplegia.
BACKGROUND
Three editions of International Classification of Headache Disorders (ICHD) diagnostic criteria for Tolosa-Hunt syndrome (THS) have been published in 1988, 2004 and 2013, in ICHD-3 beta, there have been considerable changes [corrected]. The validity of these new diagnostic criteria remains to be established.


METHODS
We retrospectively identified 77 patients with non-traumatic painful ophthalmoplegia (PO) admitted between 2003 and 2013. We reviewed patients' age at onset and gender, time courses between onset of pain and development of cranial nerve palsy, the cranial nerves involved, imaging findings, therapeutic efficacy of steroid treatment and recurrence of attacks.


RESULTS
THS was the most frequent type of PO (46/77). In THS patients, the third cranial nerve was most commonly involved (76.3%). The median time interval between pain and cranial nerve palsy was two days, although in five patients (10.9%) the interval ranged from 16 to 30 days. Definitely abnormal MRI findings were found in 24 patients (52.2%).


CONCLUSIONS
It is essential to rule out other causes of PO in diagnosing THS, with MRI playing a crucial role in differential diagnosis. It may be helpful to understand and master the entity of THS for researchers and clinicians to adjust the gradation and ranking of the diagnostic criteria.
Department of Neurology, Chinese PLA General Hospital, PR China.
Xingwen
X
Zhang
Department of Neurology, Chinese PLA General Hospital, PR China.
Zhibing
Z
Zhou
Department of Neuroscience, Norwegian University of Science and Technology, Norway.
Timothy J
TJ
Steiner
Department of Neurology, Chinese PLA General Hospital, PR China.
Wei
W
Zhang
Department of Neurology, Chinese PLA General Hospital, PR China.
Ruozhuo
R
Liu
Department of Neurology, Chinese PLA General Hospital, PR China.
Zhao
Z
Dong
Department of Neurology, Chinese PLA General Hospital, PR China.
Xiaolin
X
Wang
Department of Neurology, Chinese PLA General Hospital, PR China.
Rongfei
R
Wang
Department of Neurology, Chinese PLA General Hospital, PR China yusy1963@126.com.
Shengyuan
S
Yu
D000328:Adult; D000368:Aged; D003907:Dexamethasone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement; D038801:International Classification of Diseases; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000145:classification* / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D020333:Tolosa-Hunt Syndrome / Q000145:classification* / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome
D003907:Dexamethasone; D011241:Prednisone; D008775:Methylprednisolone
ICHD-3 beta; Painful ophthalmoplegia; Tolosa-Hunt syndrome; diagnostic criteria