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RE: gingko biloba Filters: Review, Free full text avai - PubMed

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Sender's message: Gingko Biloba, 30 artículos de texto completo de acceso libre

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Search: gingko biloba Filters: Review, Free full text available

PubMed Results

Items 1 - 30 of 30    (Display the 30 citations in PubMed)

1.	Planta Med. 2012 Sep;78(13):1458-77. doi: 10.1055/s-0032-1315117. Epub 2012 Aug 1. Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. Hermann R, von Richter O. Clinical Research Appliance, Radolfzell, Germany. robert.hermann@cr-appliance.com Abstract The use of herbal/botanical products, also referred to as complementary and alternative medicines (CAM), worldwide enjoys increasing popularity. It appears in particular highly prevalent in patient populations already exposed to complex treatment algorithms and polypharmacotherapy, frequently involving narrow therapeutic index drugs. Accordingly, the potential clinical dimension and relevance of herb-drug interactions has received considerable attention over the last years. However, review of pertinent literature indicates that the available clinical evidence in this regard is still limited and sometimes inconclusive. Also, communication of herb-drug interaction data in the biopharmaceutical/medical literature is often complex and confusing, not always unbiased, and in many cases appears not to strive for clear-cut and useful guidance in terms of the clinical relevance of such findings.This systematic review summarizes and interprets the published evidence on clinical herb-drug interaction studies which examined the potential of six popular herbal drugs (Echinacea, garlic, gingko, ginseng, goldenseal, and milk thistle) as perpetrators of pharmacokinetic (PK) drug interactions. Reported effect sizes were systematically categorized according to FDA drug interaction guideline criteria. A total of 66 clinical PK interaction studies, meeting the scope of the present review, were identified. The clinical evidence was found to be most robust and informative for Gingko biloba (GB; 21 studies) and milk thistle/silymarin (MT; 13), and appears still limited for ginseng (9), goldenseal/berberine (GS; 8), garlic (8), and Echinacea (7). Collectively, the available evidence indicates that, at commonly recommended doses, none of these herbs act as potent or moderate inhibitors or inducers of cytochrome P450 (CYP) enzymes or P-glycoprotein (ABCB1). Weak effects in terms of either induction or inhibition were found for GB (presystemic/hepatic CYP3A4 induction/inhibition, CYP2C19 induction at high doses), milk thistle/silymarin (CYP2C9 inhibition), GS/berberine (CYP3A4 and CYP2D6 inhibition), Echinacea (presystemic/hepatic CYP3A4 inhibition/induction, CYP1A2 and CYP2C9 inhibition at high doses). Information was found not always complete for the major drug metabolizing CYP enzymes in the less well-studied herbs and is largely limited to P-glycoprotein (ABCB1) when effects on drug transporters have been investigated. Georg Thieme Verlag KG Stuttgart · New York. Free Article
	PMID: 22855269 [PubMed - indexed for MEDLINE]
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2.	Planta Med. 2012 Sep;78(13):1428-57. doi: 10.1055/s-0031-1298536. Epub 2012 May 15. Phenotyping studies to assess the effects of phytopharmaceuticals on in vivo activity of main human cytochrome p450 enzymes. Zadoyan G, Fuhr U. ITECRA GmbH & Co. KG, Cologne, Germany. Abstract The extensive use of herbal drugs and their multiple components and modes of action suggests that they may also cause drug interactions by changing the activity of human cytochrome P450 enzymes. The purpose of the present review is to present the available data for the top 14 herbal drug sales in the U. S. Studies describing the effects of herbal drugs on phenotyping substrates for individual CYPs were identified by a comprehensive MEDLINE search. Drugs included Allium sativum (Liliaceae), Echinacea purpurea (Asteraceae), Serenoa repens (Arecaceae), Ginkgo biloba (Ginkgoaceae), Vaccinium macrocarpon (Ericaceae), Glycine max (Fabaceae), Panax ginseng (Araliaceae), Actea racemosa (Ranunculaceae), Hypericum perforatum (Hypericaceae), Silybum marianum (Asteraceae), Camellia sinensis (Theaceae), Valeriana officinalis (Valerianaceae), Piper methysticum (Piperaceae), and Hydrastis canadensis (Ranunculaceae) preparations. We identified 70 clinical studies in 69 publications. The majority of the herbal drugs appeared to have no clear effects on most of the CYPs examined. If there was an effect, there was mild inhibition in almost all cases, as seen with garlic or kava effects on CYP2E1 and with soybean components on CYP1A2. The most pronounced effects were induction of CYP3A and other CYPs by St. John's wort and the inhibitory effect of goldenseal on CYP3A and CYP2D6, both being borderline between mild and moderate in magnitude. With the exceptions of St.John's wort and goldenseal, the information currently available suggests that concomitant intake of the herbal drugs addressed here is not a major risk for drugs that are metabolized by CYPs. Georg Thieme Verlag KG Stuttgart · New York. Free Article
	PMID: 22588833 [PubMed - indexed for MEDLINE]
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3.	Cold Spring Harb Perspect Med. 2012 Mar;2(3):a006395. doi: 10.1101/cshperspect.a006395. Symptomatic and nonamyloid/tau based pharmacologic treatment for Alzheimer disease. Aisen PS, Cummings J, Schneider LS. University of California, San Diego, California 92093, USA. paisen@ucsd.edu Abstract In this work we consider marketed drugs for Alzheimer disease (AD) including acetylcholinesterase inhibitors (AChE-Is) and antiglutamatergic treatment involving the N-methyl-d-aspartate (NMDA) receptor. We discuss medications and substances available for use as cognitive enhancers that are not approved for AD or cognitive impairment, and other neurotransmitter-related therapies in development or currently being researched. We also review putative therapies that aim to slow disease progression by mechanisms not directly related to amyloid or tau. PMCID: PMC3282492 Free PMC Article
	PMID: 22393531 [PubMed - indexed for MEDLINE]
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4.	Mol Vis. 2012;18:390-402. Epub 2012 Feb 9. Ginkgo biloba: an adjuvant therapy for progressive normal and high tension glaucoma. Cybulska-Heinrich AK, Mozaffarieh M, Flammer J. Department of Ophthalmology, University of Basel, Basel, Switzerland. Abstract Gingko biloba has been used for hundreds of years to treat various disorders such as asthma, vertigo, fatigue and, tinnitus or circulatory problems. Two of the main extracts are EGb761 and LI 1370. Most pharmacological, toxicological and clinical studies have focused on the neuroprotective value of these two main extracts. Neuroprotection is a rapidly expanding area of research. This area is of particular interest due to the fact that it represents a new avenue of therapy for a frustrating disease that may progress despite optimal treatment. One such disease is glaucoma.Glaucoma leads to the loss of retinal ganglion cells and their axons but also to tissue remodelling which involves both the optic nerve head and the retina. In the retina the astrocytes get activated. In addition, the optic nerve gets thinner and the cells of the lateral geniculate ganglion disappear partially. On average, ocular blood flow (OBF) is reduced in glaucoma patients in various tissues of the eye. Increased intraocular pressure (IOP) is a major risk factor for glaucomatous damage. Nevertheless, there is little doubt that other risk factors besides IOP are involved. One such risk factor is a primary vascular dysregulation (PVD) occurring in patients with a disturbed autoregulation, another risk factor is oxidative stress. PMCID: PMC3283204 Free PMC Article
	PMID: 22355250 [PubMed - indexed for MEDLINE]
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5.	Adv Nutr. 2011 Jan;2(1):32-50. doi: 10.3945/an.110.000117. Epub 2011 Jan 10. Herbal extracts and phytochemicals: plant secondary metabolites and the enhancement of human brain function. Kennedy DO, Wightman EL. Brain, Performance and Nutrition Research Centre, School of Life Sciences, Northumbria University, Newcastle, UK. david.kennedy@northumbria.ac.uk Abstract Humans consume a wide range of foods, drugs, and dietary supplements that are derived from plants and which modify the functioning of the central nervous sytem (CNS). The psychoactive properties of these substances are attributable to the presence of plant secondary metabolites, chemicals that are not required for the immediate survival of the plant but which are synthesized to increase the fitness of the plant to survive by allowing it to interact with its environment, including pathogens and herbivorous and symbiotic insects. In many cases, the effects of these phytochemicals on the human CNS might be linked either to their ecological roles in the life of the plant or to molecular and biochemical similarities in the biology of plants and higher animals. This review assesses the current evidence for the efficacy of a range of readily available plant-based extracts and chemicals that may improve brain function and which have attracted sufficient research in this regard to reach a conclusion as to their potential effectiveness as nootropics. Many of these candidate phytochemicals/extracts can be grouped by the chemical nature of their potentially active secondary metabolite constituents into alkaloids (caffeine, nicotine), terpenes (ginkgo, ginseng, valerian, Melissa officinalis, sage), and phenolic compounds (curcumin, resveratrol, epigallocatechin-3-gallate, Hypericum perforatum, soy isoflavones). They are discussed in terms of how an increased understanding of the relationship between their ecological roles and CNS effects might further the field of natural, phytochemical drug discovery. PMCID: PMC3042794 Free PMC Article
	PMID: 22211188 [PubMed - indexed for MEDLINE]
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6.	Rev Bras Psiquiatr. 2010 Dec;32(4):429-36. [Medicinal plants for the treatment of generalized anxiety disorder: a review of controlled clinical studies]. [Article in Portuguese] Faustino TT, Almeida RB, Andreatini R. Laboratório de Fisiologia e Farmacologia do Sistema Nervoso Central, Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR, Brazil. Abstract OBJECTIVE: This work aimed to identify controlled trials, which evaluated effectiveness of herbal medicines in subjects suffering generalized anxiety disorder. METHOD: Controlled studies (randomized, comparative with placebo and/or standard drug, double-blind) were sought through electronic and hand-searches. The word strategy used "plant OR phytomed* OR extract OR herbal OR medicinal (OR specific name plants)" e "anxie* OR anxioly* OR tranquil* OR GAD", limited to "human OR clinical trial OR randomized controlled trial OR meta-analysis OR review". The search was restricted to English language. RESULTS: Piper methysticum presented an unequivocal anxiolytic effect, but most studies also included patients with other anxiety disorders (e.g. phobias). Isolated studies with Ginkgo biloba, Galphimia glauca, Matricaria recutita, Passiflora incarnata and Valeriana officinalis showed a potential use for anxious diseases. Despite this low number of studies, Ginkgo biloba and Matricaria recutita showed an effect size (Cohen's d=0.47 to 0.87) similar or higher to standard anxiolytics drugs (benzodiazepines, buspirone and antidepressants-0.17 to 0.38). No additional study with other plants was found. CONCLUSION: Despite the therapeutic potential of medicinal plants in generalized anxiety disorder, very few controlled trials assessing herbal medicines in generalized anxiety disorder were found. Additionally, these studies present serious flaw design. Free Article
	PMID: 21308265 [PubMed - indexed for MEDLINE]
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7.	J Alzheimers Dis. 2010;19(4):1101-22. doi: 10.3233/JAD-2010-1306. Promoting successful cognitive aging: a comprehensive review. Daffner KR. Brigham Behavioral Neurology Group, Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. kdaffner@partners.org Abstract Promoting successful cognitive aging is a topic of major importance to individuals and the field of public health. This review presents a coherent framework not only for evaluating factors, protective activities, and enhancing agents that have already been proposed, but also ones that will be put forward in the future. The promotion of successful cognitive aging involves the dual goals of preventing loss of information processing capacity and cognitive reserve, and enhancing brain capacity and cognitive reserve. Four major lines of evidence are available for evaluating whether a proposed factor promotes successful cognitive aging: 1) epidemiologic/cohort studies; 2) animal/basic science studies; 3) human "proof-of-concept" studies; and 4) human intervention studies. Each line of evidence has advantages and limitations that will be discussed. Through illustrative examples, we trace the ways in which each method informs us about the potential value of several proposed factors. Currently, lines of converging evidence allow the strongest case to be made for physical and cognitively stimulating activities. Although epidemiological data seem to favor the use of statins to lower the risk of dementia, more definitive recommendations await further randomized controlled studies. There is presently no clear evidence that antioxidants or Ginkgo biloba promote successful cognitive aging. The impact of resveratrol, fish oil, and a long list of other proposed agents needs to be determined. Clinicians remain well-positioned to identify and aggressively treat vascular risk factors, diabetes, sleep disorders, and other conditions that may reduce brain capacity, and to encourage activities that can build cognitive reserve. PMCID: PMC3047597 Free PMC Article
	PMID: 20308777 [PubMed - indexed for MEDLINE]
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8.	BMC Geriatr. 2010 Mar 17;10:14. doi: 10.1186/1471-2318-10-14. Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. Weinmann S, Roll S, Schwarzbach C, Vauth C, Willich SN. Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine, Luisenstrasse 57, Berlin, Germany. Stefan.Weinmann@charite.de Abstract BACKGROUND: The benefit of Ginkgo biloba has been discussed controversially. The aim of this review was to assess the effects of Ginkgo biloba in Alzheimer's disease as well as vascular and mixed dementia covering a variety of outcome domains. METHODS: We searched MEDLINE, EMBASE, the Cochrane databases, CINAHL and PsycINFO for controlled trials of ginkgo for Alzheimer's, vascular or mixed dementia. Studies had to be of a minimum of 12 weeks duration with at least ten participants per group. Clinical characteristics and outcomes were extracted. Meta-analysis results were expressed as risk ratios or standardized mean differences (SMD) in scores. RESULTS: Nine trials using the standardized extract EGb761(R) met our inclusion criteria. Trials were of 12 to 52 weeks duration and included 2372 patients in total. In the meta-analysis, the SMDs in change scores for cognition were in favor of ginkgo compared to placebo (-0.58, 95% confidence interval [CI] -1.14; -0.01, p = 0.04), but did not show a statistically significant difference from placebo for activities in daily living (ADLs) (SMD = -0.32, 95% CI -0.66; 0.03, p = 0.08). Heterogeneity among studies was high. For the Alzheimer subgroup, the SMDs for ADLs and cognition outcomes were larger than for the whole group of dementias with statistical superiority for ginkgo also for ADL outcomes (SMD = -0.44, 95% CI -0.77; -0.12, p = 0.008). Drop-out rates and side effects did not differ between ginkgo and placebo. No consistent results were available for quality of life and neuropsychiatric symptoms, possibly due to the heterogeneity of the study populations. CONCLUSIONS: Ginkgo biloba appears more effective than placebo. Effect sizes were moderate, while clinical relevance is, similar to other dementia drugs, difficult to determine. PMCID: PMC2846949 Free PMC Article
	PMID: 20236541 [PubMed - indexed for MEDLINE]
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9.	Am J Geriatr Pharmacother. 2009 Jun;7(3):167-85. doi: 10.1016/j.amjopharm.2009.06.003. Drug development for Alzheimer's disease: where are we now and where are we headed? Sabbagh MN. The Cleo Roberts Center for Clinical Research, Banner-Sun Health Research Institute, Sun City, AZ 85351, USA. Marwan.sabbagh@bannerhealth.com Abstract OBJECTIVE: The aim of this article was to provide a survey of the clinical development of pharmacotherapy for Alzheimer's disease (AD). METHODS: A search of PubMed to identify pertinent English-language literature was conducted using the terms Alzheimer's disease AND clinical trials (2003-2008), dementia AND prevention AND clinical trials (2003-2008), and the chemical names of all compounds mentioned in articles on new drugs for AD published since 2005. www.ClinicalTrials.gov was searched for relevant trials. Abstracts of the 2008 International Conference on Alzheimer's Disease (ICAD) were reviewed for relevance, as were pharmaceutical company and AD advocacy Web sites. Articles selected for review were primary reports of data from preclinical studies and clinical trials. RESULTS: A large number of drugs with differing targets and mechanisms of action are under development for the treatment of AD. Phase III trials of Ginkgo biloba, NSAIDs, phenserine, statins, tarenflurbil, tramiprosate, and xaliproden have been completed, none of them demonstrating adequate efficacy. Encouraging results from completed Phase II trials of dimebon, huperzine A, intravenous immunoglobulin, and methylthioninium chloride were reported at ICAD 2008. Nineteen compounds are currently in Phase II trials, and 3 compounds (AN1792, lecozotan SR, and SGS742) failed at this stage of development. CONCLUSIONS: Despite disappointing results from recently completed Phase III trials of several novel compounds, the extent and breadth of activity at all phases of clinical development suggest that new pharmacotherapeutic options for the treatment of AD will become available within the next decade. PMCID: PMC2948028 Free PMC Article
	PMID: 19616185 [PubMed - indexed for MEDLINE]
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Reenv: BONOBO SEXUAL BEHAVIOR Filters: Free full text ava - PubMed

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Subject:BONOBO SEXUAL BEHAVIOR Filters: Free full text ava - PubMed
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This message contains search results from the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM). Do not reply directly to this message

Sender's message: BONOBO SEXUAL BEHAVIOR

Sent on: Tue Oct 1 21:51:59 2013

Search: BONOBO SEXUAL BEHAVIOR Filters: Free full text available

PubMed Results

Items 1 - 5 of 5    (Display the 5 citations in PubMed)

1.	PLoS One. 2013;8(1):e55206. doi: 10.1371/journal.pone.0055206. Epub 2013 Jan 30. Bonobos respond to distress in others: consolation across the age spectrum. Clay Z, de Waal FB. Living Links, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America. zannaclay@emory.edu Abstract How animals respond to conflict provides key insights into the evolution of socio-cognitive and emotional capacities. Evidence from apes has shown that, after social conflicts, bystanders approach victims of aggression to offer stress-alleviating contact behavior, a phenomenon known as consolation. This other-orientated behavior depends on sensitivity to the other's emotional state, whereby the consoler acts to ameliorate the other's situation. We examined post-conflict interactions in bonobos (Pan paniscus) to identify the determinants of consolation and reconciliation. Thirty-six semi-free bonobos of all ages were observed at the Lola ya Bonobo Sanctuary, DR Congo, using standardized Post-conflict/Matched Control methods. Across age and sex classes, bonobos consoled victims and reconciled after conflicts using a suite of affiliative and socio-sexual behaviors including embracing, touching, and mounting. Juveniles were more likely to console than adults, challenging the assumption that comfort-giving rests on advanced cognitive mechanisms that emerge only with age. Mother-reared individuals were more likely to console than orphans, highlighting the role of rearing in emotional development. Consistent with previous studies, bystanders were more likely to console relatives or closely bonded partners. Effects of kinship, affiliation and rearing were similarly indicated in patterns of reconciliation. Nearby bystanders were significantly more likely to contact victims than more distal ones, and consolation was more likely in non-food contexts than during feeding. The results did not provide convincing evidence that bystander contacts served for self-protection or as substitutes for reconciliation. Overall, results indicate that a suite of social, developmental and contextual factors underlie consolation and reconciliation in bonobos and that a sensitivity to the emotions of others and the ability to provide appropriate consolatory behaviors emerges early in development. PMCID: PMC3559394 Free PMC Article
	PMID: 23383110 [PubMed - indexed for MEDLINE]
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2.	PLoS One. 2012;7(12):e52767. doi: 10.1371/journal.pone.0052767. Epub 2012 Dec 26. The right time to happen: play developmental divergence in the two Pan species. Palagi E, Cordoni G. Museo di Storia Naturale e del Territorio, Università di Pisa, Pisa, Italy. betta.palagi@museo.unipi.it Abstract Bonobos, compared to chimpanzees, are highly motivated to play as adults. Therefore, it is interesting to compare the two species at earlier developmental stages to determine how and when these differences arise. We measured and compared some play parameters between the two species including frequency, number of partners (solitary, dyadic, and polyadic play), session length, and escalation into overt aggression. Since solitary play has a role in developing cognitive and physical skills, it is not surprising that chimpanzees and bonobos share similar developmental trajectories in the motivation to engage in this activity. The striking divergence in play developmental pathways emerged for social play. Infants of the two species showed comparable social play levels, which began to diverge during the juvenile period, a 'timing hotspot' for play development. Compared to chimpanzees, social play sessions in juvenile bonobos escalated less frequently into overt aggression, lasted longer, and frequently involved more than two partners concurrently (polyadic play). In this view, play fighting in juvenile bonobos seems to maintain a cooperative mood, whereas in juvenile chimpanzees it acquires more competitive elements. The retention of juvenile traits into adulthood typical of bonobos can be due to a developmental delay in social inhibition. Our findings show that the divergence of play ontogenetic pathways between the two Pan species and the relative emergence of play neotenic traits in bonobos can be detected before individuals reach sexual maturity. The high play motivation showed by adult bonobos compared to chimpanzees is probably the result of a long developmental process, rooted in the delicate transitional phase, which leads subjects from infancy to juvenility. PMCID: PMC3530486 Free PMC Article
	PMID: 23300765 [PubMed - indexed for MEDLINE]
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3.	Sci Rep. 2012;2:291. doi: 10.1038/srep00291. Epub 2012 Mar 1. Communication during sex among female bonobos: effects of dominance, solicitation and audience. Clay Z, Zuberbühler K. School of Psychology, University of St Andrews. St Andrews, KY16 9JP, UK. zannaclay@emory.edu Abstract Bonobo females frequently form close bonds, which give them social power over other group members. One potential mechanism to facilitate female bonding is the performance of sexual interactions. Using naturalistic observations and experiments, we found various patterns that determined female-female sexual interactions. First, while low-ranked females interacted with all females, sexual interactions between high-ranked females were rare. Second, during genital contacts, females sometimes produced 'copulation calls', which were significantly affected by the rank of the caller and partner, as well as the solicitation direction. Third, there was a significant effect of the alpha female as a bystander, while variables relating to physical experience had no effects. Overall, results highlight the importance of sexual interactions for bonobo female social relations. Copulation calls are an important tool during this process, suggesting that they have become ritualised, beyond their reproductive function, to serve as broader social signals in flexible and potentially strategic ways. PMCID: PMC3291041 Free PMC Article
	PMID: 22389761 [PubMed - indexed for MEDLINE]
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4.	PLoS One. 2010 Sep 1;5(9). pii: e12482. doi: 10.1371/journal.pone.0012482. Y chromosomal variation tracks the evolution of mating systems in chimpanzee and bonobo. Schaller F, Fernandes AM, Hodler C, Münch C, Pasantes JJ, Rietschel W, Schempp W. Institute of Human Genetics, University of Freiburg, Freiburg, Germany. werner.schempp@uniklinik-freiburg.de Erratum in PLoS One. 2010;5(11). doi: 10.1371/annotation/14d47e6a-400a-429e-a487-6dd375e04632. Abstract The male-specific regions of the Y chromosome (MSY) of the human and the chimpanzee (Pan troglodytes) are fully sequenced. The most striking difference is the dramatic rearrangement of large parts of their respective MSYs. These non-recombining regions include ampliconic gene families that are known to be important for male reproduction,and are consequently under significant selective pressure. However, whether the published Y-chromosomal pattern of ampliconic fertility genes is invariable within P. troglodytes is an open but fundamental question pertinent to discussions of the evolutionary fate of the Y chromosome in different primate mating systems. To solve this question we applied fluorescence in situ hybridisation (FISH) of testis-specific expressed ampliconic fertility genes to metaphase Y chromosomes of 17 chimpanzees derived from 11 wild-born males and 16 bonobos representing seven wild-born males. We show that of eleven P. troglodytes Y-chromosomal lines, ten Y-chromosomal variants were detected based on the number and arrangement of the ampliconic fertility genes DAZ (deleted in azoospermia) and CDY (chromodomain protein Y)-a so-far never-described variation of a species' Y chromosome. In marked contrast, no variation was evident among seven Y-chromosomal lines of the bonobo, P. paniscus, the chimpanzee's closest living relative. Although, loss of variation of the Y chromosome in the bonobo by a founder effect or genetic drift cannot be excluded, these contrasting patterns might be explained in the context of the species' markedly different social and mating behaviour. In chimpanzees, multiple males copulate with a receptive female during a short period of visible anogenital swelling, and this may place significant selection on fertility genes. In bonobos, however, female mate choice may make sperm competition redundant (leading to monomorphism of fertility genes), since ovulation in this species is concealed by the prolonged anogenital swelling, and because female bonobos can occupy high-ranking positions in the group and are thus able to determine mate choice more freely. PMCID: PMC2931694 Free PMC Article
	PMID: 20824190 [PubMed - indexed for MEDLINE]
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5.	PLoS One. 2009 Oct 28;4(10):e7595. doi: 10.1371/journal.pone.0007595. Fellatio by fruit bats prolongs copulation time. Tan M, Jones G, Zhu G, Ye J, Hong T, Zhou S, Zhang S, Zhang L. Guangdong Entomological Institute, Guangzhou, China. Abstract Oral sex is widely used in human foreplay, but rarely documented in other animals. Fellatio has been recorded in bonobos Pan paniscus, but even then functions largely as play behaviour among juvenile males. The short-nosed fruit bat Cynopterus sphinx exhibits resource defence polygyny and one sexually active male often roosts with groups of females in tents made from leaves. Female bats often lick their mate's penis during dorsoventral copulation. The female lowers her head to lick the shaft or the base of the male's penis but does not lick the glans penis which has already penetrated the vagina. Males never withdrew their penis when it was licked by the mating partner. A positive relationship exists between the length of time that the female licked the male's penis during copulation and the duration of copulation. Furthermore, mating pairs spent significantly more time in copulation if the female licked her mate's penis than if fellatio was absent. Males also show postcopulatory genital grooming after intromission. At present, we do not know why genital licking occurs, and we present four non-mutually exclusive hypotheses that may explain the function of fellatio in C. sphinx. PMCID: PMC2762080 Free PMC Article
	PMID: 19862320 [PubMed - indexed for MEDLINE]
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Juan Gervas, doctor en medicina

 

Juan Gérvas, doctor en Medicina; nos advierte de los peligros de la medicina preventiva

"Los ricos mueren por exceso de atención médica"

Foto: Mané Espinosa

64 años. Extremeño. Vivo en Madrid. Casado con otra doctora; 4 hijos y 8 nietos. Jubilado, he sido profesor de las universidades de Valladolid, Autónoma de Madrid y Johns Hopkins, y me dedico a la docencia. Somos más que la suma de músculos y huesos. El cerebro nos supera

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Cabezas que piensan

Matrimonio de médicos bien avenido, Mercedes Pérez y Juan Gérvas firman un libro, Sano y salvo (y libre de intervenciones médicas innecesarias) -Los Libros del Lince-, que recoge lo mejor del conocimiento científico y de su propia experiencia clínica para advertirnos de los efectos secundarios del exceso de medicación, tratamientos, vacunas, chequeos... "Hay que ser prudentes frente a los talibanes de la prevención". Un libro que lleva a replantearse la salud y la enfermedad. Fueron miembros destacados del movimiento de médicos contra la vacuna de la gripe A en España y que en otros países provocó más efectos nocivos que beneficiosos, y tienen un blog muy activo.

La actividad del sistema sanitario, ¿la tercera causa de muerte?
Sí, en EE.UU. causa 225.000 muertes anuales. En España los medicamentos tienen unos 19 millones anuales de efectos adversos y provocan la muerte a 6.500 pacientes.

Oiga...
También se ha demostrado (Israel) que cuando los médicos hacen huelga las muertes disminuyen un 45%. Y mis afirmaciones se basan en estudios científicos fiables.

¿No siempre es mejor prevenir?
Los daños de la prevención se perciben a largo plazo. Hoy sabemos que por ejemplo la terapia hormonal sustitutiva para eliminar los síntomas de la menopausia, utilizada por millones de mujeres, provoca infartos, embolias y cáncer de mama (55.000 nuevos casos en el Reino Unido).

Ahora se lleva el diagnóstico precoz.
Hoy se diagnostica antes y más, pero la mortalidad es la misma. El diagnóstico precoz no mejora el diagnóstico de muerte.

¿Entonces?
Produce algo terrible: hordas de supervivientes, por ejemplo de cáncer, que viven más tiempo con el diagnóstico pero no viven más.

Qué duro.
La autoexploración de mama no disminuye la mortalidad, pero duplica las biopsias. El cáncer de cuello de útero no disminuye por hacer citologías, pero se siguen haciendo diez millones de citologías al año en España. Si quiere disminuir el cáncer de cuello de útero, céntrese en la población marginada.

¿Y el cáncer de próstata?
Si quiere reducirlo, no haga el cribado de cáncer de próstata en personas que no tengan síntomas. Hay muchísimos cánceres inofensivos, histológicos, que se diagnostican y se tratan en nombre de la prevención.

¿Desaparecen solos?
Sí, o se quedan tranquilos. Y no son tumores pequeños, el de próstata puede representar el 60%, y el de mama el 47%, pero se quita el pecho, se hace radioterapia, quimioterapia, y la vida de esa mujer girará alrededor de un cáncer que nunca la habría matado.

Entonces, ¿qué hacemos?
Disminuirían muchos cánceres haciendo menos radiología y controlando los tóxicos industriales. Pero en este complejo mundo de intereses, deseos y expectativas cuajan propuestas de prevención imposible, de intervenciones sin justificación que dañan a la población con pruebas diagnósticas y los tratamientos consecuentes.

¿Por qué remiten solos?
Normalmente, los que remiten solos no dan síntomas ni molestias, somos nosotros los que los descubrimos. En el diagnóstico precoz no se parte de población con síntomas.

¿Qué me dice de las vacunas?
Hay vacunas necesarias, pero otras como las de la gripe, el virus del papiloma humano, el neumococo, el rotavirus o la varicela son puro negocio.

¿La vacuna de la gripe no es efectiva?
Durante la pandemia de la gripe A vacunaron a la población sueca (el beneficio teórico era 50 muertos menos) y produjeron 200 casos de narcolepsia en adolescentes.

Enfermos crónicos.
Lavarse las manos disminuye mucho la transmisión de la gripe, y el 40% de los médicos y enfermeras no lo hace. Pero la vacuna de la gripe no disminuye el contagio ni las muertes, no es eficaz en personas sanas ni en personas mayores de 65 años, lo ha publicado la revista The Lancet. A la gente mayor la atiborran de pastillas, como si ser viejo fuera una enfermedad, y eso le resta calidad de vida y a menudo la mata.

¿Y la epidemia de colesterol?
Su nivel de colesterol no tiene nada que ver con su pronóstico respecto a las probabilidades de tener infarto de miocardio, y la mayoría de dichos infartos se dan en personas con colesterol normal o bajo. Además, los tratamientos para bajar el colesterol sólo son eficaces en las personas que ya tienen problemas coronarios, en todos los demás casos el tratamiento es inútil y perjudicial.

¡...!
No se mida el colesterol, sea feliz, porque ser feliz y optimista añade ocho años de vida. Y practique la dieta mediterránea, que no consiste en tomar aceite de oliva a cucharadas, sino en poner un mantel, cubiertos y tener compañía: no coma delante del televisor. Y si está embarazada, disfrute.

¿Demasiadas ecografías?
Sí, y no están justificadas, ni los suplementos rutinarios de hierro y yodo. Estados Unidos, que es el país más intervencionista y el que más dinero gasta en la atención al parto, ha triplicando su mortalidad.

¿Se muere por exceso de atención?
Sí, los pobres mueren por carencia de atención y los ricos por exceso. Un tac son 750 radiografías en un adulto y el doble en un niño. La radiación que recibió la población en Japón en la Segunda Guerra Mundial equivale a cinco tacs. ¡Ojo con los chequeos!

¿Y las vitaminas?
En los países ricos, los complementos vitamínicos son como mínimo inútiles y en muchos casos perjudiciales.

·

--    Tómate tiempo para escoger un amigo; pero sé más lento aún en cambiarlo.

 

 

 

 

 

 

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Tolosa Hunt syndrome Filters: Free full text avail - PubMed

 Tolosa Hunt syndrome Filters: Free full text available
50 artículos de acceso a texto completo

 

PubMed Results

Items 1 - 50 of 50    (Display the 50 citations in PubMed)

1.	Intern Med. 2013;52(10):1121-4. Epub 2013 May 15. Tolosa-hunt syndrome associated with cytomegalovirus infection. Okawa S, Sugawara M, Takahashi S, Otani T, Hashimoto M, Kusunoki S, Ohnishi H. Department of Neurology, Akita University Graduate School of Medicine, Japan. sato@doc.med.akita-u.ac.jp Abstract We herein present the case of a 38-year-old woman with left-sided oculomotor paralysis with ocular pain that developed after a respiratory infection. Her serum was positive for IgM against GM2 and GalNAc-GD1a gangliosides and cytomegalovirus. Thin-slice magnetic resonance imaging revealed enhanced abnormal tissue located primarily in the superolateral part of the left-sided cavernous sinus, which corticosteroids subsequently obscured with immediate resolution of the patient's ocular symptoms. These clinical features were consistent with those of Tolosa-Hunt syndrome (THS). Our findings in the present patient suggest that cytomegalovirus may provoke granuloma formation in the cavernous sinus, as reported in other various organs, thereby leading to the development of THS. Free Article
	PMID: 23676602 [PubMed - in process]
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2.	Braz J Otorhinolaryngol. 2013 Mar-Apr;79(2):256. Tolosa-Hunt syndrome mimicking cavernous sinus tumor. [Article in English, Portuguese] Beraldin BS, Felippu A, Martinelli F, Patricio HC. Felippu Institute of Otorhinolaryngology, Brazil. Free Article
	PMID: 23670334 [PubMed - indexed for MEDLINE]
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3.	J Multidiscip Healthc. 2013;6:87-91. doi: 10.2147/JMDH.S39132. Epub 2013 Mar 13. Cranial nerves XIII and XIV: nerves in the shadows. Bordoni B, Zanier E. Don Carlo Gnocchi IRCCS, Department of Cardiology, Milan. Abstract It has been known for over a century that these cranial nerves exist, and that they are not typographical errors nor a sensational event reported in the medical literature. A number of scientific articles on anatomy highlight how textbooks on descriptive anatomy do not always consider variables such as differences related to the geographical areas where people live, and these differences do exist. This is an important concept not only for surgeons, but also for all medical professionals who use manual techniques when treating their patients, ie, osteopaths, chiropractors, physiotherapists, and other manual therapists. This paper highlights the latest developments regarding these cranial nerves, offering at the same time some ideas for further reflection when looking at clinical scenarios that appear to bear little relationship to each other. Inclusion of these concepts in everyday anamnesis is encouraged. PMCID: PMC3601045 Free PMC Article
	PMID: 23516138 [PubMed]
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4.	Tohoku J Exp Med. 2013;229(1):83-6. Utility of thallium-201 scintigraphy in Tolosa-Hunt syndrome. Kakisaka Y, Kobayashi T, Uematsu M, Numata Y, Hirose M, Hino-Fukuyo N, Tsuchiya S, Doi H, Fukuda H, Kure S. Department of Pediatrics, Tohoku University School of Medicine, Miyagi, Japan. Abstract Tolosa-Hunt syndrome (THS) is a rare disorder, especially in the pediatric population, characterized by unilateral painful ophthalmoplegia with a relapsing-remitting course. Because the diagnosis of THS is based on the exclusion of other causes of painful ophthalmoplegia, attention should be paid to possible alternative diagnoses. Thallium-201 chloride ((201)Tl) scintigraphy has been used to evaluate tissue histology in clinical oncology with a marker, the retention index (RI). A higher value indicates histological malignancy. Although its utility in pediatric THS has not been discussed, we suggest that (201)Tl scintigraphy may be informative as a marker in the diagnosis. We present an 11-year-old boy with THS who was evaluated with (201)Tl scintigraphy before treatment with corticosteroids, when he had headache, photophobia, and diplopia. The RI of (201)Tl indicated that the lesion would be benign. Although his clinical symptoms did not fulfill the THS criteria completely, his eye symptoms disappeared 2 weeks after corticosteroid treatment, which was not within the 72 h as in the diagnostic criteria of THS. He has been symptom-free for more than 2 years with only an initial 4-week corticosteroid therapy. This report not only shows the potential of (201)Tl scintigraphy to contribute to the correct diagnosis of pediatric THS but also suggests the possibility that the diagnosis of THS could be supported uniquely even in a pediatric THS-suspicious patient who did not fulfill the current THS criteria completely. In conclusion, we suggest that (201)Tl scintigraphy may be useful for making the diagnosis of THS, especially in pediatric patients. Free Article
	PMID: 23291611 [PubMed - indexed for MEDLINE]
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5.	J Neurosci Rural Pract. 2012 May;3(2):193-5. doi: 10.4103/0976-3147.98240. Idiopathic hypertrophic pachymeningitis presenting with a superficial soft tissue mass. Keshavaraj A, Gamage R, Jayaweera G, Gooneratne IK. Institute of Neurology, National Hospital of Sri Lanka, Sri Lanka. Abstract Idiopathic hypertrophic pachymeningitis (IHP) is a chronic progressive diffuse inflammatory fibrosis of the dura-mater, leading to its diffuse enlargement. The following describes a case of IHP presenting with a superficial soft tissue mass. A 40-year-old female came to hospital with a subcutaneous lump over the left face and frontal headache for 6 months. An excision biopsy revealed chronic inflammation. Magnetic resonance imaging (MRI) of the brain showed left mastoiditis and early dural inflammation of the left temporal region. A few months later, she developed diplopia, complex partial seizures, and retrobulbar neuritis of the left optic nerve. Repeat MRI brain demonstrated meningeal thickening on both sides of the tentorium cerebelli extending to the left tempero-parietal meninges. The meningeal biopsy revealed markedly thickened fibro-connective dural tissue with infiltration of chronic inflammatory cells. There was no evidence of bacterial, fungal, tuberculous or neoplastic infiltration. IHP was diagnosed and steroid therapy initiated. Within weeks, she showed marked clinical improvement. IHP is a diagnosis of exclusion. The absence of underlying infective, neoplastic, or systemic autoimmune disease favors IHP. The above patient had headache, neuro-ophthalmic signs, seizures, which are features of IHP. However, superficial soft tissue involvement is rare. PMCID: PMC3409998 Free PMC Article
	PMID: 22865979 [PubMed]
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6.	Intern Med. 2012;51(12):1591-3. Epub 2012 Jun 15. Isolated trochlear nerve palsy in Tolosa-Hunt syndrome. Tsuda H, Hisada M, Tanaka K, Miura Y, Kishida S. Department of Neurology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan. Abstract A 67-year-old Japanese woman without contributory medical history developed acute onset of left-sided trochlear nerve palsy (TNP) with persistent and severe periorbital pain. There were no other neurological abnormalities. Funduscopic findings were normal. Cranial and orbital magnetic resonance (MR) imaging, and cranial MR angiography demonstrated no abnormalities. By administration of prednisolone 40 mg/day from the day after onset, periorbital pain was resolved within 24 hours, and TNP within 5 days. Thereafter, prednisolone was gradually tapered off. She remained asymptomatic under no medication. In the English language literature, this is the first reported case of Tolosa-Hunt syndrome presenting with isolated TNP. Free Article
	PMID: 22728496 [PubMed - indexed for MEDLINE]
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7.	Rev Neurol. 2012 Jun 16;54(12):729-33. [Tolosa-Hunt syndrome following traumatic eye injury]. [Article in Spanish] Granados-Reyes GM, Soriano-Redondo E, Duran-Ferreras E. Hospital Infanta Elena, Huelva, Spain. Abstract INTRODUCTION: Tolosa-Hunt syndrome (THS) is an idiopathic condition involving unilateral eye pain with involvement of oculomotor nerves which responds well to treatment with steroids. It is produced by idiopathic granulomatous inflammation of the cavernous sinus or the orbital apex. CASE REPORT: A 37-year-old male who was admitted to hospital due to a six-week history of blurred vision and pain in the left eye, which was later accompanied by full ipsilateral ophthalmoplegia. Some days prior to the onset of the clinical features, he suffered an accident which resulted in traumatic injury to the left eye. An examination showed data pointing to optic neuropathy in the left eye with complete extrinsic ocular motor palsy. Results of general analyses and lumbar puncture were normal. Magnetic resonance imaging (MRI) of the head revealed a thickening of the wall of the left cavernous sinus and of the ipsilateral orbital apex, which enhanced with gadolinium. Evoked potential studies showed axonal and demyelinating optic neuropathy on the left-hand side. Suspecting this to be a case of THS, treatment was established with high doses of corticoids, which brought about an improvement in the pain and eye movement but not in the blurred vision. A MRI control scan showed a clear improvement in comparison to the one carried out initially. CONCLUSIONS: In cases of painful ophthalmoplegia, the professional should suspect the existence of THS. If the apex of the orbit is affected through the superior orbital fissure, the optic nerve may be damaged. Traumatic injury can be one of the situations that trigger THS. Free Article
	PMID: 22673949 [PubMed - indexed for MEDLINE]
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8.	Rev Neurol. 2011 Jan 16;52(2):90-4. [Recurrent painful ophthalmoplegia secondary to polyostotic fibrous dysplasia of the maxillary sinuses with involvement of the superior orbital fissure]. [Article in Spanish] Navarro-Munoz S, Rueda-Medina I, Recio-Bermejo M, Del Saz-Saucedo P, Espejo-Martinez B, Garcia-Ruiz R, Ortega-Leon T, Turpin-Fenoll L. Hospital La Mancha Centro, Alcazar de San Juan, Espana. satinamu@hotmail.com Abstract INTRODUCTION: Fibrous dysplasia is a bone disease that is usually accompanied by asymptomatic lesions but which may sometimes display neurological manifestations due to the involvement of the craniofacial bones. CASE REPORT: A 25-year-old female, with a history of migraines, who visited at the age of 18 due to pain in the right retro-ocular and maxillary region, although with characteristics that were unlike those of her usual migraines, and which was associated with ipsilateral ophthalmoparesis. The condition had a self-limiting course and responded well to corticoids, although it was recurring. Examination revealed intense pain on palpation of the right-hand maxillary sinus and incomplete paralysis of the ipsilateral oculomotor nerve with palpebral ptosis. Results of complementary studies were normal, except for magnetic resonance imaging of the head and computerised axial tomography of the face, which revealed an expansive lesion with involvement of the right superior maxillary sinus and the greater wing of the sphenoid bone, with probable compromise of the superior orbital fissure, consistent with the diagnosis of fibrous dysplasia, which was confirmed by means of a pathology study. CONCLUSIONS: Fibrous dysplasia is a benign bone disorder, of unknown causation, in which normal bone tissue is replaced by amorphous conjunctive tissue. There is sometimes craniofacial involvement and a hypertrophic bone mass is formed which can fill the paranasal sinuses and the orbit, resulting in exophthalmus and visual disorders. To date the scientific literature does not include any reports of this disease manifesting as bouts of recurrent painful ophthalmoparesis which responds to corticoids, as happened in the case of our patient. Free Article
	PMID: 21271548 [PubMed - indexed for MEDLINE]
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9.	Neurol Med Chir (Tokyo). 2010;50(6):499-502. Metastatic skull base tumor from thymic carcinoma mimicking Tolosa-Hunt syndrome. Tsutsumi S, Abe Y, Yasumoto Y, Shiono S, Ito M. Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan. shotaro@juntendo-urayasu.jp Abstract A 39-year-old male without contributory medical history had sustained progressive double vision, ptosis, and trigeminal pain for 2 weeks. Physical examination revealed total ophthalmoplegia and visual field defect with normal blood examination and chest radiography. Cranial computed tomography revealed a hyperdense mass in the left frontotemporal fossae with bony erosion. Magnetic resonance imaging confirmed a broad-based, intensely enhanced extraaxial tumor of 4x4x4 cm diameter with dural tail sign. Cerebral angiography demonstrated insignificant blood supply both from the internal carotid and middle meningeal arteries. Nearly total tumor resection was achieved via orbitofrontotemporal craniotomy. Intraoperative findings revealed the extraaxial tumor with broad attachment to the dura mater and invasion to the optic and oculomotor nerves. Histological examination revealed hypercellular tumor with significant cell atypism, mitotic activity, and focal necrosis. Immunohistochemical staining was positive for AE1/3 and c-kit, but negative for glial fibrillary acidic protein. Systemic examination performed postoperatively revealed a thymic tumor without additional remote lesions. The final diagnosis was metastatic brain tumor from thymic carcinoma. Rapid progression of neurological impairment inconsistent with a benign extraaxial tumor needs prompt surgical intervention. Free Article
	PMID: 20587979 [PubMed - indexed for MEDLINE]
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10.	J Headache Pain. 2010 Jun;11(3):285. doi: 10.1007/s10194-010-0206-3. Epub 2010 Mar 25. A prospective multicentre study to evaluate the consistency of the IHS diagnostic criteria, the usefulness of brain MRI for the diagnosis, follow-up and treatment management, and the outcome after high dosage 6-methylprednisolone therapy, in subjects with Tolosa-Hunt syndrome. Colnaghi S, Versino M, Marchioni E, Tassorelli C, Bastianello S, Sandrini G, Nappi G.PMCID: PMC3451910 Free PMC Article
	PMID: 20336343 [PubMed - indexed for MEDLINE]
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11.	Cases J. 2009 Sep 17;2:8271. doi: 10.4076/1757-1626-2-8271. Painful ophthalmoplegia of the left eye in a 19-year-old female, with an emphasis in Tolosa-Hunt syndrome: a case report. Mendez JA, Arias CR, Sanchez D, Pesci LM, Lopez BS, Lopez R, Castro E. Department of Internal Medicine, Calzada de Tlalpan 4800, Colonia Sección XVI, Tlalpan, C.P. 14080. Distrito Federal, México. juan_spp@yahoo.com.mx Abstract INTRODUCTION: Painful ophthalmoplegia refers to periorbital or hemicraneal pain plus ipsilateral ocular motor nerve palsies with or without oculo-sympathetic paralysis, sensory loss in the distribution of V1 and V2 can co-occur. There are many etiologies of painful ophthalmoplegia. Tolosa-Hunt syndrome is a steroid-responsive painful ophthalmoplegia secondary to idiopatic granulomatous inflammation of the cavernous sinus or orbital apex. THS is a diagnosis of exclusion and treatment should be with high dose steroid. CASE PRESENTATION: We describe the case of a 19-year-old female that was admitted to our hospital for painful ophthalmoplegia of the left eye. After the diagnostic work-up, we concluded that the patient had a benign form of Tolosa-Hunt syndrome. We initiated treatment with steroids and 72 hours later saw a response. CONCLUSION: In conclusion, steroid treatment is the cornerstone in the management of THS. Even though there is no standardized dose specified in the literature, this type of treatment with steroids at a dose of 1 mg/kg/day tapered slowly over 3 to 4 months has been well received. PMCID: PMC2769420 Free PMC Article
	PMID: 19918410 [PubMed]
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12.	Arch Soc Esp Oftalmol. 2009 Jan;84(1):43-6. [Painful incomplete third-nerve palsy caused by an internal carotid-communicating posterior artery aneurysm]. [Article in Spanish] Pérez-Flores MI, Velasco-Casares M, Lorenzo-Carrero J. Servicio de Oftalmología, Hospital POVISA, C/. Salamanca 5, Vigo (Pontevedra), Spain. mari-nes@eresmas.net Abstract CLINICAL CASE: A 38-year-old woman presented acute-onset, painful incomplete third-nerve palsy caused by an internal carotid-posterior communicating artery (IC-PC) aneurysm. We describe the differential diagnosis with Tolosa-Hunt syndrome and the results after endovascular treatment. DISCUSSION: The presence of pupil-sparing third-nerve palsy may not exclude the presence of an IC-PC aneurysm and orbital magnetic resonance imaging and/or computed tomography imaging must be performed in these cases. The prompt recovery after endovascular treatment is consistent with previous reports. Free Article
	PMID: 19173138 [PubMed - indexed for MEDLINE]
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13.	BMJ Case Rep. 2009;2009. pii: bcr08.2008.0804. doi: 10.1136/bcr.08.2008.0804. Epub 2009 Mar 17. Extramedullary plasmacytoma masquerading as Tolosa-Hunt syndrome: a case report. Ko S, Huang SY, Liu CY. Taoyuan General Hospital, Internal Medicine, No.1492, Jhongshan Road, Taoyuan City, Taoyuan County 330, Taiwan. Abstract Painful ophthalmoplegia due to extramedullary plasmacytoma is a rare initial manifestation of multiple myeloma. The present report describes a 48-year-old man who suffered an acute onset of retro-orbital pain, left abducens palsy and left facial hypoesthesia. In addition, he exhibited an elevated erythrocyte sedimentation rate and partial responsiveness to corticosteroid treatment, all of which resemble the features of Tolosa-Hunt syndrome. Imaging studies revealed a multilobulated tumour invading the left sphenoid bone and sphenoid sinus, later confirmed as a plasmacytoma at pathology. Multiple myeloma was also diagnosed by bone marrow examination. After completion of chemotherapy and radiotherapy, the patient has been free of symptoms for 10 months. Although cranial neuropathies with any combination of oculomotor, abducens, trochlear, ophthalmic and maxillary nerves may indicate a cavernous sinus lesion, neuropathies exclusive to the abducens and maxillary nerves may raise the possibility of extracavernous sinus origin. Cranial imaging is crucial in diagnosing painful ophthalmoplegia with additional minimal cranial nerve signs. PMCID: PMC3029032 Free PMC Article
	PMID: 21686622 [PubMed]
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14.	Arch Soc Esp Oftalmol. 2007 Aug;82(8):509-12. [Painful ophthalmoplegia (pseudotumor of the orbit and Tolosa-Hunt syndrome)]. [Article in Spanish] Mora-de-Oñate J, Pascual-Pérez-Alfaro R, Izquierdo-Vázquez C, González-Ruiz M, Aguirrebeña-Olmos A, Díez-Villalba R. Departamento de Oftalmología, Hospital Universitario de Getafe, Madrid, España. javimora79@hotmail.com Abstract INTRODUCTION: The Tolosa-Hunt Syndrome (THS) and the Pseudotumor of the Orbit (PTO) each have three common clinical hallmarks: unilateral periorbital pain, cranial nerve palsies and a fast response to corticosteroid therapy. CASE REPORT: 48-year-old female with a right VI nerve paralysis, later develops a right III nerve paralysis. It is important to be able to differentiate between THS and PTO, and this is done on the basis of the complementary tests. DISCUSSION: Apart from neuroradiologic findings, the clinical presentation and histopathology of these two conditions are very similar, making it difficult to distinguish between them. Aspects common to both pathological processes are discussed. Free Article
	PMID: 17717772 [PubMed - indexed for MEDLINE]
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15.	Neurol Med Chir (Tokyo). 2007 Feb;47(2):85-8. Granulomatous pachymeningitis around the sella turcica (Tolosa-Hunt syndrome) involving the hypophysis--case report. Kita D, Tachibana O, Nagai Y, Sano H, Yamashita J. Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Ishikawa., Japan. kitad@ns.m.kanazawa-u.ac.jp Abstract A 50-year-old female presented with right painful abducens nerve palsy persisting for 4 months and mild panhypopituitarism with diabetes insipidus for 6 months. T(1)-weighted magnetic resonance (MR) imaging of the sellar region showed a homogeneously enhanced mass lesion in the right cavernous sinus which seemed to extend from the swollen pituitary gland. T(2)-weighted MR imaging clearly showed the mass in the right cavernous sinus and the thickened dura mater of the sellar floor as hypointense, and the enlarged pituitary gland as isointense. Biopsy of the thickened dura mater and swollen pituitary gland was performed via the transsphenoidal approach. Histological examination revealed inflammation and collagen fiber formation in these regions. The diagnosis was secondary panhypophysitis resulting from granulomatous pachymeningitis involving the cavernous sinus (Tolosa-Hunt syndrome). Corticosteroid therapy was begun after the biopsy. Her periorbital pain and diplopia were relieved, but diabetes insipidus persisted. Follow-up MR imaging showed a decrease in the volumes of the pituitary gland and the mass in the cavernous sinus. Free Article
	PMID: 17317948 [PubMed - indexed for MEDLINE]
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16.	Arq Bras Oftalmol. 2006 Sep-Oct;69(5):737-9. [Ophthalmoplegic migraine: case report]. [Article in Portuguese] Monzillo PH, Saab VM, Protti GG, Sanvito WL. Disciplina de Neurologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil. monzillo@einstein.br Abstract Ophthalmoplegic migraine is a rare syndrome in which episodic fixed unilateral headaches are associated with ipsilateral ophthalmoplegia. Its physiopathology remains obscure. We describe a case in a patient with ophthalmoplegic migraine diagnosed according to the International Headache Society (IH-2004) criteria, who showed an unusual clinical presentation. The first ophthalmoplegic migraine episode occurred in adult life. Pain side changed in one episode. Oculomotor abnormalities were painless during the last crisis. Since diagnosis is made by exclusion, differential diagnosis and need for etiologic investigation are discussed. Free Article
	PMID: 17187145 [PubMed - indexed for MEDLINE]
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17.	AJNR Am J Neuroradiol. 2006 Nov-Dec;27(10):2217-20. Inflammatory myofibroblastic tumor of the orbit with associated enhancement of the meninges and multiple cranial nerves. McKinney AM, Short J, Lucato L, SantaCruz K, McKinney Z, Kim Y. Department of Radiology, University of Minnesota Medical School & Hennepin County Medical Center, Minneapolis 55415, USA. mckin022@umn.edu Abstract Inflammatory myofibroblastic tumor (IMT), Tolosa-Hunt syndrome (THS), and idiopathic hypertrophic pachymeningitis (IHP) seem to be part of a spectrum of disorders that have diverse locations but similar histologic and imaging findings. We report a case of a 50-year-old man presenting with multiple progressive cranial nerves palsies with leptomeningeal cranial nerve enhancement on MRI (II, V1-V3, and X), orbital and infraorbital masses, prominence within the left cavernous sinus, and diffuse dural enhancement. Biopsies of the orbital lesion and infraorbital nerve revealed IMT. The patient's lesions, symptoms, and dural enhancement quickly improved with steroid administration and nearly resolved over multiple subsequent scans over the next few months. This case illustrates a rare case of pseudotumor mimicking a more aggressive appearance that would usually portend a case of malignancy. There is a potential association of IMT, THS, and IHP, which may have existed in a concomitant fashion in this patient. The case also describes the unique finding of enhancement of the cisternal segments of multiple cranial nerves (simulating leptomeningeal malignant involvement), which may be related to inflammatory perineural edema or ischemic neuropathy. Free Article
	PMID: 17110698 [PubMed - indexed for MEDLINE]
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18.	Singapore Med J. 2006 Aug;47(8):712-5. Multiple cranial nerve palsies associated with type 2 diabetes mellitus. Singh NP, Garg S, Kumar S, Gulati S. Nephrology Division, Maulana Azad Medical College, New Delhi 110002, India. Abstract Although isolated cranial nerve palsies are common in patients with diabetes mellitus, multiple simultaneous cranial neuropathies are rare. We report a 48-year-old man, a known case of diabetes mellitus, who presented with facial palsy, foot drop and painful ophthalmoplegia of the left eye. The initial differential diagnosis included diabetic polyneuropathy, septic cavernous sinus thrombosis, mucormycosis and the Tolosa Hunt syndrome. Magnetic resonance (MR) imaging findings were consistent with those of the Tolosa Hunt syndrome. The patient had a remarkable complete resolution of his ophthalmoplegia after four weeks of steroid treatment, with repeat MR imaging showing resolution of the initial changes. Free Article
	PMID: 16865214 [PubMed - indexed for MEDLINE]
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19.	Rev Neurol. 2006 May 1-15;42(9):530-4. [Tolosa-Hunt syndrome and orbital pseudotumour. Overlapping conditions in a case with an unusual clinical profile]. [Article in Spanish] Hamad-Cueto O, Tamayo-Toledo JA, Mármol-Prados AA, Garcia-Trujillo L, López-Madrona JC, Fernández-Fernández O. Department of Neurology, Hospital Regional Universitario Carlos Haya, Avda. Carlos Haya s/n, E-29010 Malaga, Spain. ohacu@hotmail.com Abstract INTRODUCTION: The origin of Tolosa-Hunt syndrome (THS) and orbital pseudotumour (OP) is not fully understood. It is acknowledged as having an unspecific granulomatous inflammatory nature in different locations. Although there are differences between the clinical features of the two conditions, they also share a number of physiopathogenetic, therapeutic and, in some cases, iconographic similarities. Possible clinical recurrences are common in the two conditions and a broad differential diagnosis is required in all cases. Yet, the association of both processes in the same patient, with radiological proof of the migration of the inflammatory injury, is not frequent. CASE REPORT: We report the case of a male patient with a long history of recurring unilateral painful ophthalmoplegia that was sensitive to steroids; criteria for THS were fulfilled and there was later development of homolateral OP, six years after the onset of his symptoms. The findings in serial studies conducted with magnetic resonance imaging must be highlighted. The patient was submitted to a surgical intervention to treat the orbital injury and a chronic inflammatory process was observed in the fibrotic phase. CONCLUSIONS: Inflammatory pseudotumour and THS perhaps have more points in common than has traditionally been accepted. To our knowledge few cases of the above-mentioned association have been reported in the same patient. When confronted by cases of painful ophthalmoplegia with excessive recurrences the physician must consider the possibility of other alternative diagnoses. Free Article
	PMID: 16676276 [PubMed - indexed for MEDLINE]
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20.	Arq Neuropsiquiatr. 2005 Sep;63(3A):648-51. Epub 2005 Sep 9. [Tolosa-Hunt syndrome: analysis of six cases]. [Article in Portuguese] Monzillo PH, Saab VM, Protti GG, Costa AR, Sanvito WL. Santa Casa de São Paulo, São Paulo, SP, Brazil. monzillo@einstein.br Abstract Tolosa-Hunt syndrome is an entity of rare occurrence and unknown etiopathogenesis, expressed clinically by unilateral orbitary pain associated with simple or multiple oculomotor paralysis, which resolves spontaneously but may recur. We present a series of six cases taken care in our ambulatory, which fulfill the diagnostic criteria for Tolosa Hunt syndrome according to the International Headache Society Classification of 2004. There are also emphasized the demographic data of this series of patients, their 12 months follow-up, investigative studies and responsiveness to corticosteroids. As the diagnosis is always of exclusion, literature revision is focused on differential diagnosis of painful ophthalmoplegic syndromes. Free Article
	PMID: 16172716 [PubMed - indexed for MEDLINE]
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21.	Rev Neurol. 2005 Jul 1-15;41(1):30-3. [Recurrent Tolosa-Hunt syndrome with normal neuroimaging. A report of three cases]. [Article in Spanish] Jiménez-Caballero PE, Florensa J, Marsal-Alonso C, Alvarez-Tejerina A. Neurology Service, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Murillo 14, E-45592 Bargas, Toledo, Spain. pjimenez1010j@yahoo.es Abstract INTRODUCTION: Tolosa-Hunt syndrome is caused by an unspecific inflammation in the cavernous sinus or superior orbital fissure. Recurrence occurs in 40% of cases. Magnetic resonance (MR) of the head and orbital phlebography can reveal characteristic data, although diagnosis is reached by exclusion according to International Headache Society criteria. Corticoids are the preferred treatment, since their use gives rise to the disappearance of the clinical condition in a few days. CASE REPORT: We describe the cases of three patients with recurrent Tolosa-Hunt syndrome and MR images of the head with normal contrast. Case 1: a 52-year-old male with paralysis of the oculomotor nerve with recurrence on the contralateral side. Case 2: a 42-year-old female with recurrent paralysis of the abducent nerve. Case 3: a 34-year-old male with involvement of the oculomotor nerve, optic nerve and the first branch of the trigeminal nerve with recurrence of the ophthalmoplegia. In all cases the clinical symptoms disappeared with the use of corticoid therapy. CONCLUSIONS: The oculomotor disorder is produced by nerve infiltration and not by compression. The time for recurrence varies largely, and the clinical condition in the recurrence is usually milder owing to the fact that diagnosis is reached and treatment is started earlier. The absence of alterations in the MR of the head does not rule out the existence of Tolosa-Hunt syndrome, even in cases of recurrence, and these disorders therefore should not be included in the diagnostic criteria. Free Article
	PMID: 15999327 [PubMed - indexed for MEDLINE]
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22.	Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2005 Feb;30(1):20, 37. [Ophthalmoparalysis: cause by diabetes mellitus or Tolosa-Hunt syndrome?]. [Article in Chinese] Xie QY, Wu J, Zhong HJ. Free Article
	PMID: 15871181 [PubMed - indexed for MEDLINE]
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23.	Arq Neuropsiquiatr. 2005 Mar;63(1):173-5. Epub 2005 Apr 13. [Ophthalmoplegic migraine: MRI findings. Case report]. [Article in Portuguese] Farage L, Castro MA, Macedo TA, Borges PC, Souza LP, Freitas LO. Hospital das Clinicas, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil. lucianofarage@yahoo.com.br Abstract Ophthalmoplegic migraine is a rare syndrome in which headache is associated with ophthalmoplegia and third, fourth or sixth cranial nerves palsy. It occurs most frequently in childhood and teenagers. At magnetic resonance imaging (MRI) with gadolinium (GD-DTPA) it may be observed a transitory enhancement of the affected nerve. We present the case of a male teenager, 16 years old, with typical medical history and enhanced signal at left oculomotor nerve in cisternal portion at MRI weighted in T1 with GD-DTPA. On the control exam, eighteen months later, there was no remarkable lesion. The enhancement of oculomotor nerve at MRI is always pathological and among the differential diagnosis we must include: neoplasia (lymphoma and leukemia), infections (AIDS, syphilis), inflammatory process (sarcoidose and Tolosa-Hunt syndrome) and vascular (posterior communicating artery aneurysm). Free Article
	PMID: 15830088 [PubMed - indexed for MEDLINE]
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24.	AJNR Am J Neuroradiol. 2005 Apr;26(4):946-50. Normal cranial nerves in the cavernous sinuses: contrast-enhanced three-dimensional constructive interference in the steady state MR imaging. Yagi A, Sato N, Taketomi A, Nakajima T, Morita H, Koyama Y, Aoki J, Endo K. Department of Diagnostic Radiology and Nuclear Medicine, Gunma University School of Medicine, Showa-machi, Maebashi Gunma, Japan. Abstract BACKGROUND AND PURPOSE: Three-dimensional (3D) constructive interference in steady state (CISS) MR imaging is useful for demonstrating cranial nerves (CNs) in the cistern. The purpose of this study was to evaluate normal CNs III, IV, V1, V2, and VI in the cavernous sinuses by using contrast-enhanced, three-dimensional (3D), Fourier transformation CISS MR imaging. METHODS: In 76 normal cavernous sinuses from 38 patients, detectability of CNs III-VI in the bilateral cavernous sinuses was evaluated by using contrast-enhanced 3D CISS MR imaging. In 40 cavernous sinuses from 20 patients, contrast-enhanced 3D CISS and contrast-enhanced T1-weighted MR imaging were compared for the detectability of these CNs. RESULTS: Each CN was separately demonstrated, and in 11 patients (29%), all CNs in the cavernous sinuses were identified on contrast-enhanced 3D CISS MR imaging. The images depicted the intracavernous segments of CNs III, IV, V1, V2, and VI in 76 (100%), 46 (61%), 70 (92%), 67 (88%), and 73 (96%) of the 76 sinuses, respectively. In comparison of imaging techniques, contrast-enhanced 3D CISS MR imaging had a detection rate significantly higher than that of enhanced T1-weighting imaging (P < .05) in all CNs except for CN III, which was detected in 100% of cases with both techniques. CONCLUSION: Contrast-enhanced 3D CISS MR imaging provides clear images of each CN in the cavernous segment. This useful method may contribute to the diagnosis of diseases involving the cavernous sinuses, such as Tolosa-Hunt syndrome. Free Article
	PMID: 15814950 [PubMed - indexed for MEDLINE]
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25.	Rev Neurol. 2004 Jun 16-30;38(12):1152-5. [Binocular diplopy as the presentation of a haematoma in the rectus inferior]. [Article in Spanish] Turpín-Fenoll L, Carneado-Ruiz J, Pampliega-Pérez A, Martí-Martínez S, Alfaro-Sáez A, García-Escrivà A. Departamento de Neurología, Hospital General Universitario de Alicante, Alicante, Spain. lturdoc@hotmail.com Abstract INTRODUCTION: The presence of quick onset binocular diplopy makes it essential to carry out a comprehensive differential diagnosis. The most frequent causes in adults include vascular, post-traumatic, tumorous and myopathic pathologies. Yet, to perform a differential diagnosis we also have to take into account less common aetiologies such as demyelinating disease, carotid-cavernous fistulas and Tolosa Hunt syndrome, among others. We report the case of a patient who was admitted to our hospital because she presented an acute onset diplopy secondary to a spontaneous haematoma of the left rectus inferior. CASE REPORT: We describe the case of a 54-year-old female with a history of hypercholesterolemia, who was a smoker and allergic to iodine contrasts and who visited because of an acute onset diplopy accompanied by instability and pain in the left eye. The neurological examination revealed paresis of the extraocular muscles dependent on the left oculomotor nerve with left palpebral ptosis, paresis of the rectus inferior, with no involvement of the pupils. Other results of the exploration were within normal limits. A computerised axial tomography scan of the head showed a haemorrhage in the rectus inferior. Magnetic resonance images of the head revealed an increase in the volume of the left-side rectus inferior with signs of bleeding, and the rest of the complementary explorations were normal. The patient progressed favourably and the diplopy gradually disappeared. CONCLUSIONS: Spontaneous bleeding of the extraocular muscles, although infrequent, must be taken into account in the differential diagnosis of painful ophthalmoplegia with diplopy in patients with no underlying pathology, especially in the absence of other neurological disorders. Free Article
	PMID: 15229830 [PubMed - indexed for MEDLINE]
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26.	J Neurol Neurosurg Psychiatry. 2004 Mar;75(3):436-40. Acute ophthalmoparesis in the anti-GQ1b antibody syndrome: electrophysiological evidence of neuromuscular transmission defect in the orbicularis oculi. Lo YL, Chan LL, Pan A, Ratnagopal P. Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore. gnrlyl@sgh.com.sg Abstract OBJECTIVE: To prospectively study anti-GQ1b antibody positive cases of acute ophthalmoparesis (AO) clinically and electrophysiologically. METHODS: Nine consecutive cases presenting with predominantly acute ophthalmoplegia were assessed clinically and had stimulated single fibre electromyography (SFEMG) of the orbicularis oculi at presentation. All had magnetic resonance imaging brain scans and anti-GQ1b antibody titres determined. RESULTS: Four cases had elevated anti-GQ1b antibody titres and abnormal SFEMG studies, which improved in tandem with clinical recovery over three months. Five other anti-GQ1b antibody negative cases were diagnosed as diabetic related cranial neuropathy, idiopathic cranial neuropathy, ocular myasthenia gravis, and Tolosa-Hunt syndrome. All five cases showed complete recovery over a three month period. CONCLUSIONS: This study demonstrated electrophysiologically the dynamic improvement of neuromuscular transmission of anti-GQ1b antibody positive cases of AO, in tandem with clinical recovery. SFEMG is of value in differentiating weakness due to neuromuscular transmission defect from neuropathy in these clinical situations. PMCID: PMC1738963 Free PMC Article
	PMID: 14966161 [PubMed - indexed for MEDLINE]
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27.	Neurol India. 2003 Mar;51(1):137. Tolosa-Hunt syndrome: MRI before and after treatment. Koul R, Jain R. Department of Child Health (Neurology), Sultan Qaboos University Hospital, Oman. Free Article
	PMID: 12865561 [PubMed - indexed for MEDLINE]
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28.	Arch Soc Esp Oftalmol. 2003 Jan;78(1):43-6. [Painful ophthalmoplegia secondary to larynx carcinoma]. [Article in Spanish] Alvarez Suárez ML, Alvarez-Buylla Camino M, Barbón García JJ, Morís De La Tassa G, Pastor Hernández L. Hospital Alvarez-Buylla, Mieres, Asturias, España. Abstract CASE REPORT: We present a case of metastatic larynx cancer in the cavernous sinus. It presented itself as a right sixth cranial nerve palsy which progressed into a painful ophthalmoplegia with normal CT and RNM in its early stages. DISCUSSION: We must suspect a cavernous sinus invasion in patients with cranial nerve palsies and with a history of malignancy, despite negative radiologic findings. Tumoral invasion of the skull base has been described in pharyngeal neoplasms but it is exceptional in larynx carcinomas. Free Article
	PMID: 12571774 [PubMed - indexed for MEDLINE]
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29.	J Neurol Neurosurg Psychiatry. 2001 Nov;71(5):577-82. The Tolosa-Hunt syndrome. Kline LB, Hoyt WF. Department of Ophthalmology, University of Alabama School of Medicine, 601 700 South 18th Street, Birmingham, Alabama, USA. lkline@uabmc.edu PMCID: PMC1737614 Free PMC Article
	PMID: 11606665 [PubMed - indexed for MEDLINE]
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30.	Br J Ophthalmol. 2001 Oct;85(10):1220-4. A role for methotrexate in the management of non-infectious orbital inflammatory disease. Smith JR, Rosenbaum JT. Casey Eye Institute, Oregon Health Sciences University, Portland, Oregon 97201-4197, USA. smithjus@ohsu.edu Abstract AIM: To evaluate the clinical usefulness of methotrexate for patients with non-infectious orbital inflammatory disease who fail to respond to systemic corticosteroids and/or orbital irradiation. METHODS: The medical records of patients with non-infectious orbital inflammatory disease who were treated with methotrexate at Oregon Health Sciences University between June 1993 and June 2000 were examined. Methotrexate was administered at a median maximum dose of 20 mg per week (range 15-25 mg per week) in conjunction with folate supplementation. Patients were followed with regular ophthalmic examinations, as well as serum liver enzyme levels and blood cell counts. Clinical signs of regression of the orbital inflammation, visual acuity, dosage and duration of methotrexate therapy, requirement for concurrent corticosteroid administration, and adverse drug reactions were recorded. RESULTS: The study cohort included 14 patients (24 eyes) with diagnoses including non-specific orbital inflammation (n=7), Tolosa-Hunt syndrome (n=1), thyroid orbitopathy (n=3), Wegener's granulomatosis (n=1), sarcoidosis (n=1), and Erdheim-Chester disease (n=1). In all cases, methotrexate was commenced as a corticosteroid sparing agent. 10 patients (71%) completed a 4 month therapeutic trial of methotrexate. Median duration of treatment for the nine (64%) patients who experienced clinical benefit was 25 months (range 10-47 months). Six responders were ultimately able to cease methotrexate, including the single patient who required concurrent long term corticosteroid therapy. Complications included fatigue, gastrointestinal disturbance, hair thinning and mild, reversible serum liver enzyme elevation. Two patients (14%) discontinued treatment because of adverse effects. CONCLUSION: Methotrexate is a well tolerated immunosuppressive medication which may benefit patients with recalcitrant non-infectious orbital inflammatory disease. PMCID: PMC1723732 Free PMC Article
	PMID: 11567968 [PubMed - indexed for MEDLINE]
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31.	J Rheumatol. 2001 Jul;28(7):1740-2. Tolosa-Hunt syndrome mimicking giant cell arteritis. Hussain M, Rodriguez FJ, Johnson LN, Komatireddy G, Walker SE. Free Article
	PMID: 11469494 [PubMed - indexed for MEDLINE]
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32.	AJNR Am J Neuroradiol. 2001 May;22(5):876-9. Tumefactive fibroinflammatory lesion of the neck with progressive invasion of the meninges, skull base, orbit, and brain. Holodny AI, Kirsch CF, Hameed M, Sclar G. Department of Radiology, New Jersey Medical School, University Hospital, 150 Bergen Street, Newark, NJ 07103, USA. Abstract SUMMARY: Tumefactive fibroinflammatory lesions of the head and neck are rare. CNS involvement has not been reported. We present a histologically proven case of a tumefactive fibroinflammatory lesion that originated in the left side of the neck and progressed over 2 years to involve the meninges, the cavernous sinuses, the right temporal lobe, and the right orbit. The lesion caused destruction of the skull base and a subdural hematoma. The relationship of the present lesion to idiopathic hypertrophic pachymeningitis and Tolosa-Hunt syndrome is discussed. Free Article
	PMID: 11337332 [PubMed - indexed for MEDLINE]
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33.	J Neuroradiol. 1999 Mar;26(1):68-72. Tolosa Hunt syndrome: a case report. Clinical and magnetic resonance imaging findings. Alioglu Z, Akbas A, Sari A, Erdöl H, Ozmenoglu M. Department of Neurology, Karadeniz Technical University Faculty of Medicine Trabzon/Turkey. Abstract A 36-year-old woman was admitted with a left abducens nerve palsy. MR showed enlargement of the left cavernous sinus. The patient was treated with 80 mg oral methyl prednisolone. Clinical findings improved within a month. Two months later, she was readmitted with left oculomotor and right abducens nerve palsy. MR showed significant increase in the volume of the abnormal area in the left cavernous sinus and a new lesion within the right cavernous sinus. After intravenous gadolinium DTPA, there was enhancement in both cavernous sinuses. Methyl prednisolone therapy was again started. After one month of treatment neurological examination was normal. Follow-up MR findings were similar to previous ones. Free Article
	PMID: 10363446 [PubMed - indexed for MEDLINE]
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34.	Nephrol Dial Transplant. 1998 Sep;13(9):2370-2. Tolosa-Hunt syndrome in uraemic patients undergoing maintenance haemodialysis. Tatsumi H, Takeuchi Y, Hanaoka M, Okubo M, Kamata K. Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. Free Article
	PMID: 9761527 [PubMed - indexed for MEDLINE]
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35.	Endocr J. 1996 Oct;43(5):503-10. Parasellar chronic inflammatory disease presenting Tolosa-Hunt syndrome, hypopituitarism and diabetes insipidus: a case report. Hama S, Arita K, Kurisu K, Sumida M, Kurihara K. Department of Neurosurgery, Hiroshima University School of Medicine, Japan. Abstract We describe a 60-year-old man with a history of Tolosa-Hunt syndrome associated with intermittent painful ophthalmoplegia and a visual disturbance on the left side, who presented with signs and symptoms of severe hypoadrenalism and diabetes insipidus. Magnetic resonance imaging demonstrated enlargement of the hypophysis and infundibulum and left cavernous sinus. An endocrinologic study revealed anterior pituitary dysfunction and diabetes insipidus. The patient underwent a transsphenoidal biopsy which revealed chronic inflammation in the hypophysis, mucosa of the sphenoid sinus, and dura mater. The patient was treated with steroids that decreased the size of the hypophysis and infundibulum, but the symptoms of anterior pituitary insufficiency and diabetes insipidus have persisted. The chronic inflammation of the hypophysis and infundibulum is thought to have spread from the cavernous sinus. Free Article
	PMID: 8980889 [PubMed - indexed for MEDLINE]
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36.	Kurume Med J. 1996;43(2):165-70. Tolosa-Hunt syndrome with atypical intrasellar and juxtasellar lesions--two case reports. Takahashi Y, Abe T, Kojima K, Ochiai S, Miyagi J, Shigemori M. Department of Neurosurgery, Kurume University School of Medicine, Japan. Abstract Two patients with Tolosa-Hunt syndrome (THS) who had atypical lesions in the intrasellar and juxtasellar regions are reported. They manifested with painful ophthalmoplegia. Magnetic resonance imaging (MRI) commonly showed an increase in the volume of the cavernous sinus occupied by homogeneously well-enhanced lesions in both cases. These lesions extended to the intrasellar and juxtasellar regions with meningela enhancement. Follow-up MRI after steroid treatment demonstrated normalized or decreased size of the cavernous sinus. These findings suggested nonspecific inflammatory granulomatosis with atypical extension. Free Article
	PMID: 8755120 [PubMed - indexed for MEDLINE]
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37.	Intern Med. 1995 Nov;34(11):1093-6. Inflammatory involvement of the hypophysis in Tolosa-Hunt syndrome. Hida C, Yamamoto T, Endo K, Tanno Y, Saito T, Tsukamoto T. Department of Neurology, Fukushima Medical College. Abstract We report a case of painful ophthalmoplegia (Tolosa-Hunt syndrome), which was complicated with diabetes insipidus (DI) and pituitary-adrenal axis hypofunction. A 42-year-old man hospitalized for left orbital pain and impairment of left cranial nerves III, IV, V, VI, developed diabetes insipidus during the corticosteroid treatment. Neuroimaging studies disclosed a thickened, highly contrast-enhanced pituitary stalk, swollen pituitary gland and widened left cavernous sinus up to the superior orbital fissure, which were accompanied by diabetes insipidus and hypofunction of the pituitary-adrenal axis. These were indicative of an extension of granulomatous inflammation of the cavernous sinus to the pituitary portal system and the gland itself. Free Article
	PMID: 8774971 [PubMed - indexed for MEDLINE]
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38.	AJNR Am J Neuroradiol. 1995 Apr;16(4 Suppl):942-4. Gadopentetate dimeglumine-enhanced MR in the diagnosis of the Tolosa-Hunt syndrome. Zournas C, Trakadas S, Kapaki E, Doris S, Gatzonis S, Gouliamos A, Papageorgiou C. Department of Neurology, Aeginition Hospital, Athens, Greece. Abstract A 54-year-old man first was admitted with a right oculomotor nerve palsy that ameliorated spontaneously. Two months later, he was readmitted with right proptosis, ophthalmoplegia, and optic nerve involvement. MR showed an enlarged right cavernous sinus. There was dramatic improvement after high doses of steroids. MR findings 10 months later were normal. Thus, the diagnosis of the Tolosa-Hunt syndrome was established. Free Article
	PMID: 7611080 [PubMed - indexed for MEDLINE]
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39.	Neurol Med Chir (Tokyo). 1995 Jan;35(1):28-31. Tolosa-Hunt syndrome with unusual clinical courses--two case reports. Imai F, Kiya N, Ogura Y, Nomura M, Gireesh K, Sano H, Kanno T. Department of Neurosurgery, Fujita Health University School of Medicine, Aichi. Abstract Two cases of Tolosa-Hunt syndrome with unusual clinical courses are described. The clinical onset of the first patient was typical, but was unresponsive to steroid hormone treatment. The symptoms resolved spontaneously after 1 year. Computed tomography (CT) and magnetic resonance (MR) imaging revealed enlargement of the affected cavernous sinus, which did not change after the symptoms resolved. The clinical presentation in the second patient included marked pupillary dilatation, a sign which is absent in the classical criteria. CT showed no abnormal findings, but MR imaging revealed a mass located in the medial side of the cavernous sinus extending to the lateral wall, which might have caused the pupillary dilatation. After steroid therapy the symptoms disappeared and MR imaging showed remarkable reduction of the mass in the cavernous sinus. Tolosa-Hunt syndrome usually responds promptly to steroid therapy and rarely manifests marked pupillary dilatation. Such variation in presentation adds to the difficulties in diagnosis and treatment of this disease of unknown etiology. Free Article
	PMID: 7700479 [PubMed - indexed for MEDLINE]
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40.	Indian J Ophthalmol. 1994 Dec;42(4):207-9. Computerised tomography in Tolosa-Hunt syndrome. Pandit L, Rao S. Department of Neurology, Kasturba Hospital, Manipal. Abstract Twelve patients who satisfied the clinical criteria of Tolosa-Hunt syndrome (THS), underwent axial computerised tomography (CT) scan of the head. Two patients had abnormalities detected in the cavernous sinus on the affected side which supported the clinical diagnosis. This coupled with steroid responsiveness and long-term asymptomatic follow-up firmly established the diagnosis of THS. We discuss the computerised tomographic findings seen in THS and the relevance of using accurate imaging techniques as the first line of investigation in these cases. Free Article
	PMID: 10576999 [PubMed - indexed for MEDLINE]
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41.	J Neurol Neurosurg Psychiatry. 1990 Dec;53(12):1034-42. Idiopathic and symptomatic trigeminal pain. Cruccu G, Leandri M, Feliciani M, Manfredi M. Department of Neurosciences, University of Rome, La Sapienza, Italy. Abstract The trigeminal reflexes (corneal reflex, blink reflex, masseter inhibitory periods, jaw-jerk) and far field scalp potentials (nerve, root, brainstem, subcortical) evoked by percutaneous infraorbital stimulation were recorded in 30 patients with "idiopathic" trigeminal neuralgia (ITN) and 20 with "symptomatic" trigeminal pain (STP): seven postherpetic neuralgia, five multiple sclerosis, four tumour, two vascular malformation, one Tolosa-Hunt syndrome, and one traumatic fracture. All the patients with STP and two of those with ITN had trigeminal reflex abnormalities; 80% of patients with STP and 30% of those with ITN had evoked potential abnormalities. The results indicate that 1) trigeminal reflexes and evoked potentials are both useful in the examination of patients with trigeminal pain, and in cases secondary to specific pathologies provide 100% sensitivity; 2) in "symptomatic" and "idiopathic" paroxysmal pain the primary lesion affects the afferent fibres in the proximal portion of the root or the intrinsic portion in the pons; 3) primary sensory neurons of the A-beta fibre group are involved in both paroxysmal and constant pain, but in the latter the damage is far more severe. PMCID: PMC488310 Free PMC Article
	PMID: 2292693 [PubMed - indexed for MEDLINE]
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42.	J Neurol Neurosurg Psychiatry. 1990 Mar;53(3):231-4. Abnormality in the cavernous sinus in three patients with Tolosa-Hunt syndrome: MRI and CT findings. Goto Y, Hosokawa S, Goto I, Hirakata R, Hasuo K. Department of Neurology, Faculty of Medicine, Kyushu University, Fukuoka, Japan. Abstract Three patients with Tolosa-Hunt syndrome (THS) were examined using computed tomography (CT), orbital venography and magnetic resonance imaging (MRI). CT of the brain showed no definite abnormality in two patients, right optic nerve enlargement and an abnormal area around the orbital apex in one patient. Orbital venography showed an occlusion of the superior ophthalmic vein in one of three patients. MRI showed an abnormal soft tissue area in the cavernous sinus, with intermediate to high signal intensity on T1- or intermediate weighted images. There was clinical improvement following corticosteroid therapy and the abnormal soft tissue on MRI decreased in volume and in signal intensity, although this was equivocal in one patient. Thus MRI proved to be useful in demonstrating lesions in the cavernous sinus in patients with THS. PMCID: PMC1014134 Free PMC Article
	PMID: 2324755 [PubMed - indexed for MEDLINE]
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43.	J Neurol Neurosurg Psychiatry. 1989 Nov;52(11):1290-3. Clinicopathological correlation in a case of painful ophthalmoplegia: Tolosa-Hunt syndrome. Goadsby PJ, Lance JW. Department of Neurology, Prince Henry Hospital, NSW, Australia. Abstract A case of painful ophthalmoplegia due to idiopathic granulomatous involvement of the superior orbital fissure (Tolosa-Hunt syndrome) is described. The clinical features of recurrent pain, ocular motor nerve palsies and proptosis correlated well with the eventual demonstration of an enhancing mass in the region of the cavernous sinus. Removal of the lesion led to a resolution of the clinical picture and demonstration of a non-caseating granuloma with no other detectable cause. The original observation of Tolosa was thus re-affirmed. PMCID: PMC1031640 Free PMC Article
	PMID: 2592972 [PubMed - indexed for MEDLINE]
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44.	Neurol Med Chir (Tokyo). 1989 Oct;29(10):944-7. [Tolosa-Hunt syndrome. Report of a surgical case]. [Article in Japanese] Matsumoto T, Kitano I, Tanaka Y, Kuratsu J, Ushio Y. Abstract A 58-year-old male presented with painful right ophthalmoplegia and was diagnosed as having Tolosa-Hunt syndrome. High-dose oral administration of a corticosteroid provided significant pain relief, but total ophthalmoplegia persisted. Computed tomography (CT) showed a tumor-like mass in the bilateral cavernous sinus. Angiography revealed occlusion of the right internal carotid artery. According to the literature, about 70% of cases of Tolosa-Hunt syndrome are caused by parasellar neoplasms. A transcranial biopsy of the patient's lesion revealed a nonspecific granulomatous process in the wall of the right cavernous sinus. He was again placed on high-dose corticosteroid therapy and within 1 week the right visual acuity improved slightly. The corticosteroid dose was gradually tapered over 3 months. After 2 months of therapy, the external ocular movement had almost fully recovered, although the light reflex was absent and the CT findings did not change. Free Article
	PMID: 2482947 [PubMed - indexed for MEDLINE]
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45.	Br J Ophthalmol. 1988 Apr;72(4):299-302. Computerised axial tomography and magnetic resonance scanning in the Tolosa-Hunt syndrome. Thomas DJ, Charlesworth MC, Afshar F, Galton DJ. Department of Medicine, Radiology, and Neurosurgery, St Bartholomew's Hospital, London. Abstract A 50-year-old Asian male presented with a left sixth nerve palsy, left temporal pain, and rapidly deteriorating visual acuity in the left eye. A high resolution CT scan and magnetic resonance scan showed a left retro-orbital enhancing lesion extending from the lateral margin of the cavernous sinus on to the greater wing of the sphenoid and into the left orbit. Arteriography was normal. On high dose steroid therapy there was total resolution of the lesion. The value of imaging techniques in this condition is discussed. PMCID: PMC1041437 Free PMC Article
	PMID: 3378027 [PubMed - indexed for MEDLINE]
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46.	J Neurol Neurosurg Psychiatry. 1983 Jun;46(6):576-8. Psychophysical assessment of a patient with Tolosa-Hunt syndrome. Fallowfield LJ, Rees JE. Abstract Patients may complain of impaired vision and yet exhibit no abnormalities when tested with conventional tests of visual acuity. Some sensitive psychophysical tests used by psychologists and neurophysiologists to examine the function of the normal visual system are beginning to gain recognition as useful tools in clinical situations. They are particularly sensitive indicators of damage to the visual pathways. The results are presented of one such application which characterises the visual defects of a patient with a suspected diagnosis of Tolosa-Hunt Syndrome. PMCID: PMC1027455 Free PMC Article
	PMID: 6875594 [PubMed - indexed for MEDLINE]
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47.	J Neurol Neurosurg Psychiatry. 1979 Mar;42(3):270-5. Remittent painful ophthalmoplegia: the Tolosa-Hunt syndrome? A report of seven cases and review of the literature. Dornan TL, Espir ML, Gale EA, Tattersall RB, Worthington BS. Abstract Seven patients with remittent painful ophthalmoplegia for which no specific local cause was found were seen during a period of five years. One had coincidental rheumatoid arthritis, and another had actinomycosis of the ipsilateral middle ear and contralateral parotid gland. The other five had no evidence of generalised autoimmune disease nor any other systemic disorder, two having separate episodes affecting each side. A history of relapsing and remitting painful ophthalmoplegia is suggestive of the Tolosa-Hunt syndrome, but it is rarely possible to confirm that the lesion in the cavernous sinus is the result of non-specific granulomatous infiltration so that the diagnosis remains one of exclusion. Carotid arteriography may show narrowing of the intracavernous part of the internal carotid artery. Orbital venography may also be helpful, particularly when the carotid arteriogram is normal. We believe that the Tolosa-Hunt syndrome is more common in England than is generally realised, but that its clinical features do not necessarily indicate a single pathological entity. Its recognition is important since the response to steroids, although not specific, is rapid in most patients, and the prognosis for complete recovery is relatively good. PMCID: PMC490732 Free PMC Article
	PMID: 438837 [PubMed - indexed for MEDLINE]
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48.	Indian J Ophthalmol. 1977 Jul;25(2):22-6. Tolosa Hunt syndrome. Zafrulla KM, Dhir SP, Jain IS. Free Article
	PMID: 615146 [PubMed - indexed for MEDLINE]
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49.	Br J Ophthalmol. 1975 Mar;59(3):149-54. Tolosa-Hunt syndrome. The dangers of an eponym. Fowler TJ, Earl CJ, McAllister VL, McDonald WI. Abstract Two cases of painful ophthalmoplegia are described which were initially thought to be examples of the Tolosa-Hunt syndrome. Both were partially responsive to steroid treatment. Subsequent investigations showed that in one case the condition was due to an aneurysm and in the other to a malignant lymphoma. PMCID: PMC1017371 Free PMC Article
	PMID: 1131355 [PubMed - indexed for MEDLINE]
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50.	J Neurol Neurosurg Psychiatry. 1973 Jun;36(3):486-90. Superior orbital fissure syndrome. Some clinical and radiological observations. Hallpike JF. Abstract A patient is described with features of a superior orbital fissure (Tolosa Hunt) syndrome and a coexistent intraorbital lesion. There was radiological evidence both of narrowing of the carotid artery and of an intraorbital obstruction of venous return from the orbit. The diagnostic value of orbital venography and carotid angiography in the investigation of granulomata in the region of the orbit is stressed. The condition described here is responsive to corticosteroids and it is also inferred that there may be a clinicopathological spectrum encompassing both the Tolosa Hunt syndrome and pseudotumour of the orbit. PMCID: PMC494350 Free PMC Article
	PMID: 4714112 [PubMed - indexed for MEDLINE]
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