Ertilav Esra, Akyol Ali
Department of Neurology, Algology, Adnan Menderes University, Aydin, Turkey.
Neuroophthalmology. 2024 Apr 29;48(5):338-347. doi: 10.1080/01658107.2024.2336270. eCollection 2024.
This study aims to establish the final definite etiology among patients with long-term follow-up for painful ophthalmoplegia. The data of 44 cases (16 females, 28 females) were examined. In the first diagnosis, subjects were scanned in terms of benign and secondary etiologies. Clinical and radiological follow-up results of patients were recorded. During the follow-up period, data on clinical outcomes (relapse or progression), treatment responses, and final diagnoses were evaluated In total, 49 episodes of painful ophthalmoplegia (44 patients) were evaluated. Secondary etiologies were identified in 21 patients benign/secondary tumours causes in 10, inflammatory in 1, infectious in 3, vascular in 3, demyelinating disease in 1, autoimmune in 2, drug-related cause in 1. 23 patients with benign etiologies; 11 had Tolosa-Hunt syndrome (THS), 2 had Recurrent Painful Ophthalmoplegic Neuropathy (RPON), and 10 had diabetic ophthalmoparesis (DO). 7 of 11 patients with THS met the International Classification Headache Disorders 3rd edition (ICHD-3 beta) criteria, 4 were with a normal MRI, and 1 had a recurrence. 9 of 10 patients with benign/secondary tumours causes were malignant, and 7 died due to disease progression during the treatment process. One of ten patient was followed with diabetic ophthalmoparesis and was diagnosed with cavernous sinus involvement of B-cell lymphoma as a result of clinical progression during follow-up. Painful ophthalmoplegia is a complex clinical condition with a broad differential diagnosis with malignant and benign etiologies. A detailed clinical examination, imaging, and long-term follow-up are essential for accurate diagnosis and treatment management.
本研究旨在明确长期随访的疼痛性眼肌麻痹患者的最终确切病因。对44例患者（16例男性，28例女性）的数据进行了检查。初诊时，对患者进行了良性和继发性病因的筛查。记录患者的临床和影像学随访结果。在随访期间，评估了临床结局（复发或进展）、治疗反应和最终诊断的数据。总共评估了49例疼痛性眼肌麻痹发作（44例患者）。21例患者发现继发性病因，其中良性/继发性肿瘤导致的有10例，炎症性的1例，感染性的3例，血管性的3例，脱髓鞘疾病1例，自身免疫性的2例，药物相关原因1例。23例患者为良性病因；11例患有托洛萨-亨特综合征（THS），2例患有复发性疼痛性眼肌麻痹性神经病（RPON），10例患有糖尿病性眼肌麻痹（DO）。11例THS患者中有7例符合国际头痛疾病分类第3版（ICHD-3 beta）标准，4例MRI正常，1例复发。10例良性/继发性肿瘤病因患者中有9例为恶性，7例在治疗过程中因疾病进展死亡。10例糖尿病性眼肌麻痹患者中有1例在随访期间因临床进展被诊断为海绵窦受累的B细胞淋巴瘤。疼痛性眼肌麻痹是一种复杂的临床病症，鉴别诊断范围广泛，包括恶性和良性病因。详细的临床检查、影像学检查和长期随访对于准确诊断和治疗管理至关重要。
