Tolosa-Hunt sindrom: da li je neophodno prikazati granulom?

  • Ana Podgorac Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Mental Health, Belgrade, Serbia
  • Jasna Zidverc-Trajković Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
  • Zagorka Jovanović Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
  • Aleksandar Ristić Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
  • Aleksandra Radojičić Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
  • Aleksandra Pavlović Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
  • Milija Mijajlović Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
  • Tamara Švabić-Medjedović Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
  • Nadežda Čovičković-Šternić Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP150703180P
Ključne reči: tolosa-hunt syndrome||, ||tolosa-huntov sindrom, brain||, ||mozak, diagnosis||, ||dijagnoza, diagnosis, differential||, diferencijalna, magnetic resonance imaging||, ||magnetna rezonanca, snimanje.,

Sažetak


Uvod. Sindrom Tolosa–Hunt (THS) je redak entitet koji se odlikuje jednostranim orbitalnim bolom udruženim sa parezom jednog ili više okulomotornih nerava, uzrokovanim granulomatoznim zapaljenjem kavernoznog sinusa, gornje orbitalne fisure ili orbite. Niska prevalencija ovog sindroma, kao i široki spektar drugih oboljenja koja bi mogla uzrokovati bolnu oftalmoplegiju, doprineli su pooštravanju dijagnostičkih kriterijuma za THS u poslednjem izdanju Međunarodne klasifikacije glavobolja. Važećim kriterijumima zahteva se dokazivanje prisustva granuloma magnetnom rezonancom ili biopsijom. Visoka varijabilnost kliničke prezentacije THS može biti uzrok otežanog postavljanja dijagnoze, uz odlaganje početka lečenja. Smanjenje broja bolesnika koji bi na osnovu kliničke slike mogli imati THS, ali ne ispunjavaju sve dijagnostičke kriterijume, dalje komplikuje i odlaže pravovremeno postavljanje tačne dijagnoze. Prikaz bolesnika. Prikazali smo osam bolesnika lečenih pod dijagnozom THS. I pored isključenja drugih uzroka bolne oftalmoplegije, granulom nije bilo moguće prikazati kod četiri bolesnika. Klinička prezentacija THS kod bolesnika sa i bez dokazanog prisustva granuloma, nije se razlikovala značajno kada su u pitanju osobine glavobolje (lokalizacija, intenzitet, kvalitet, trajanje pre razvoja slabosti okulomotora, odgovor na kortikosteroidnu terapiju), zahvaćenost kranijalnih nerava, trajanje bolesti i odgovor na terapiju, kao ni dijagnostički postupak sproveden sa ciljem isključivanja drugih bolesti koje bi mogle biti uzrok bolne oftalmoplegije. Zaključak. Ne postoji značajna razlika između bolesnika sa THS bez obzira na to da li je granulom dokazan ili ne.

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Objavljeno
2017/06/21
Broj časopisa
Vol. 74 Br. 3 (2017)
Rubrika
Prikaz bolesnika