Stubbing-Moore Alex, Uraiby Hussein, Lam Vincent, Anwar-Bhatti Samira
Department of Ophthalmology, University Hospitals of Leicester NHS Trust, Leicester, UK.
Department of Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK.
Neuroophthalmology. 2024 Jun 27;49(1):87-94. doi: 10.1080/01658107.2024.2367054. eCollection 2025.
We report a case of painful left abducens nerve palsy that progressed to a left cavernous sinus syndrome (CSS). The initial differential diagnosis was Tolosa-Hunt syndrome (THS), but the clinical course was atypical. Subsequently, perineural invasion (PNI) was demonstrated, after biopsy of a previously occult undiagnosed new cutaneous squamous cell carcinoma (SCC) of the forehead. This case emphasizes the challenges of diagnosing painful ophthalmoplegia when there is an absence of positive neuroimaging or typical findings. The take home message is that a detailed medical history and high index of suspicion are necessary in suspected THS.
我们报告一例左侧外展神经麻痹伴疼痛，进而发展为左侧海绵窦综合征（CSS）的病例。最初的鉴别诊断为托洛萨-亨特综合征（THS），但其临床病程并不典型。随后，在前额一处先前隐匿未被诊断出的新发皮肤鳞状细胞癌（SCC）活检后，证实存在神经周围侵犯（PNI）。该病例强调了在缺乏阳性神经影像学表现或典型特征时，诊断疼痛性眼肌麻痹所面临的挑战。关键信息是，对于疑似THS的病例，详细的病史和高度的怀疑指数是必要的。
