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KMID : 0911820140150020086
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Korean Journal of Headache
2014 Volume.15 No. 2 p.86 ~ p.89
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A Case of Painful Ophthalmoplegia with Normal Cranial Imaging: Diabetic Ophthalmic Neuropathy or Benign Tolosa-Hunt Syndrome?
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Han Sang-Woo
Ha Sang-Won
Kang Jin-Ho
Joo Jae-Jeong
Kim Seung-Min
Yang Yung-Soon
Han Jung-Ho
Cho Eun-Kyung
Kim Doo-Eung
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Abstract
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Painful ophthalmoplegia with normal cranial imaging is rare and confined to limited etiologies. Ocular diabetic neuropathy (ODN) due to microvasculopathy frequently demonstrates as painful ophthalmoplegia with normal neuroimaging studies. Ophthalmoplegic migraine, which frequently occurs in childhood may also present as this condition. Half of the patients with clinical presentation and diagnosis of Tolosa-Hunt Syndorme (THS), an inflammatory process of unknown etiology, have no radiographic evidence of inflammation. The eponym “benign THS” has been introduced for patients with THS and normal neuroimaging findings. We present a 68-year-old diabetic patient with painful ophthalmoplegia. In spite of extensive work up, we could not find any radiologic abnormality. It is possible that our patient has THS according to slow progression, CSF protein elevation and multiple cranial involvements. However this patient might also be diagnosed with ODN according to old age, DM, period between pain and paresis, and relatively poor response in ocular motor function recovery. ODN and benign THS are accounted for most of the painful ophthalmoplegias in patients with normal cranial imaging. Patient outcomes were generally good.
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KEYWORD
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Ocular diabetic neuropathy, Benign Tolosa-Hunt syndrome
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