A CPH-Like Picture in Two Patients with an Orbitocavernous Sinus Syndrome

Foerderreuther, S.; Maydell, R v; Straube, Andreas

doi:10.1046/j.1468-2982.1997.1705608.x

Cited by 12 publications

(11 citation statements)

References 13 publications

(5 reference statements)

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“…42,43 Similarly, secondary chronic paroxysmal hemicrania has also been reported with a syndrome like Tolosa-Hunt syndrome. 44,45 In our group of 11 patients, indomethacin relieved pain in eight of them. One of these patients had to use amitriptyline and pizotifen concurrently to achieve complete pain relief.…”

Section: Discussionmentioning

confidence: 67%

“…By analogy to cluster headache, calcium‐channel blockers such as nicardipine and flunarizine have been successful in aborting episodic paroxysmal hemicrania, 38 as has verapamil in chronic paroxysmal hemicrania, 39–41 with a similar efficacy to indomethacin. Chronic paroxysmal hemicrania can coexist with trigeminal neuralgia 44 just as cluster headache 42,43 . Similarly, secondary chronic paroxysmal hemicrania has also been reported with a syndrome like Tolosa–Hunt syndrome 44,45 …”

Section: Discussionmentioning

confidence: 99%

“…Chronic paroxysmal hemicrania can coexist with trigeminal neuralgia 44 just as cluster headache 42,43 . Similarly, secondary chronic paroxysmal hemicrania has also been reported with a syndrome like Tolosa–Hunt syndrome 44,45 …”

Section: Discussionmentioning

confidence: 99%

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Paroxysmal hemicrania and cluster headache: two discrete entities or is there an overlap?

Fuad

Jones

2002

Clin Otolaryngol

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Paroxysmal hemicrania has been described as an excruciating unilateral pain, which is usually ocular and frontotemporal with short-lasting (2-45 min), frequent attacks (usually more than five per day); with marked autonomic features (rhinorrhoea, nasal congestion, conjunctival injection, lacrimation) and unilateral to the pain. A response to indomethacin is essential using the current criteria for the diagnosis. It is a rare condition but when it occurs it is misdiagnosed as being due to sinusitis. A retrospective analysis of 11 patients seen in the period 1995-2001 suggests that there is an overlap between paroxysmal hemicrania and cluster headache. Four patients had all the characteristics of paroxysmal hemicrania and responded to indomethacin. Four other patients fulfilled the criteria except for the frequency and length of the attacks. They only had one attack per day and these lasted more than 2 h. Another patient had all the symptoms of paroxysmal hemicrania and did not respond to indomethacin, but responded to triptans and pizotifen. Patients with cluster headache typically respond to these. Two patients were unable to continue taking indomethacin owing to severe gastrointestinal upset. In the same period, we also had 30 patients with cluster headaches. There is increasing evidence that paroxysmal hemicrania and cluster headache share a similar pathogenesis and that they may not always be so discrete in either their response to indomethacin or their periodicity.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Paroxysmal hemicrania and cluster headache: two discrete entities or is there an overlap?

Fuad

Jones

2002

Clin Otolaryngol

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“…The cases reported by Foederreuther et al (9) showed many features that resemble the Tolosa–Hunt syndrome but later on, the symptoms of both cases were similar to CPH, including the response to indomethacin. Structural abnormalities in the cavernous sinus region were present in both cases.…”

Section: Discussionmentioning

confidence: 89%

Chronic Paroxysmal Hemicrania as a Manifestation of Intracranial Parotid Gland Carcinoma Metastasis — A Case Report

et al. 2004

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A 67-year-old-white woman presented with a 3-month history of anorexia (loss of 10 kg), and a left preauricular tumoral mass. A few days after the first clinical evaluation, a left peripheral facial paralysis was noted. The biopsy of the tumoral mass showed an epidermoid parotid gland adenocarcinoma. A complete left parotidectomy, with unilateral cervical ganglionectomy was performed. After surgery the patient received local (left parotid area and ipsilateral neck and shoulder areas) radiation therapy during three months. Eighteen days after the end of the radiotherapy sessions, she complained of a right forehead and temporal headache, more intense in the retro-orbital region. The headache was excruciating and described as throbbing or stabbing pain. The attacks usually last about 20 min, associated with tearing, conjunctival injection and Horner's sign ipsilateral to the pain side and their frequency ranges from 10 to 20 attacks per day. There were diurnal and nocturnal attacks. During the attacks the patient prefers to stay alone in a quiet room. A dull background pain persists in the right retro-orbital area between the attacks. The patient denied any precipitating factor.The neurological examination was unremarkable except for a left peripheral facial paralysis. Analgesics and oxygen-inhalation administration were worthless. A trial with Indomethacin at 75 mg/day led to absolute pain control.One month later, however, it was necessary to raise the indomethacin dosage to 150 mg/day and the patient developed an abducent nerve paralysis on the right side. A MRI study showed T1 hypointense lesions and T2 hyperintense lesions, with ring-like -peripheral reinforcement in the right cerebellar hemisphere, vermis, right corpus callosus and right cavernous sinus, suggestive of metastasis ( Fig. 1). Three months later, the pain became continuous, moderate in intensity, without associated autonomic signs and was no longer responsive to indomethacin. The patient received chemotherapy but death occurred one month later.

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“…In the past, the absence of radiographic evidence of inflammation in patients with THS was confusing to clinicians, and a diagnosis of “idiopathic painful ophthalmoplegia” was applied to these patients [30-32]. The eponym of “benign THS” was first introduced by La Mantia et al in 2006 to describe these patients [9].…”

Section: Discussionmentioning

confidence: 99%

Painful ophthalmoplegia with normal cranial imaging

et al. 2014

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BackgroundPainful ophthalmoplegia with normal cranial imaging is rare and confined to limited etiologies. In this study, we aimed to elucidate these causes by evaluating clinical presentations and treatment responses.MethodsCases of painful ophthalmoplegia with normal cranial MRI at a single center between January 2001 and June 2011 were retrospectively reviewed. Diagnoses of painful ophthalmoplegia were made according to the recommendations of the International Headache Society.ResultsOf the 58 painful ophthalmoplegia cases (53 patients), 26 (44.8%) were diagnosed as ocular diabetic neuropathy, 27 (46.6%) as benign Tolosa-Hunt syndrome (THS), and 5 (8.6%) as ophthalmoplegic migraine (OM). Patients with ocular diabetic neuropathy were significantly older (62.8 ± 7.8 years) than those with benign THS (56.3 ±12.0 years) or OM (45.8 ± 23.0 years) (p < 0.05). Cranial nerve involvement was similar among groups. Pupil sparing was dominant in each group. Patients with benign THS and OM responded exquisitely to glucocorticoid treatment with resolved diplopia, whereas patients with ocular diabetic neuropathy didn’t (p < 0.05). Patients with OM recovered more rapidly than the other groups did (p < 0.05). Overall, most patients (94.8%) recovered completely during the follow-up period.ConclusionsOcular diabetic neuropathy and benign THS accounted for most of the painful ophthalmoplegias in patients with normal cranial imaging. Patient outcomes were generally good.

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A CPH-Like Picture in Two Patients with an Orbitocavernous Sinus Syndrome

Cited by 12 publications

References 13 publications

Paroxysmal hemicrania and cluster headache: two discrete entities or is there an overlap?

Paroxysmal hemicrania and cluster headache: two discrete entities or is there an overlap?

Chronic Paroxysmal Hemicrania as a Manifestation of Intracranial Parotid Gland Carcinoma Metastasis — A Case Report

Painful ophthalmoplegia with normal cranial imaging

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