何望凯 　谢文君　胡华

[摘要] Tolosa-Hunt综合征是在颈内动脉海绵窦段及其附近硬脑膜的非特异性炎症或肉芽肿相关性疾病。主要表现为眼球后及眶周顽固性疼痛，疼痛数日后出现眼肌外肌麻痹，动眼神经、滑车神经、展神经均可受累。由于活检限制及MRI敏感性及特异性问题，THS的诊断较为困难。本文通过个案报道分享痛性眼肌麻痹的诊疗思路，采用病史及体格检查尽可能精确定位、辅助检查手段验证及排除相关疾病的方法，尽可能的节约医疗费用及提高阳性病灶的确诊率，减少误诊及漏诊。治疗上强调中西医结合治疗，中医辩证论治，针药并用，能起到扶正驱邪、减轻激素副作用、改善患者症状、缩短病程、减少复发及调理全身等作用。

[关键词] Tolosa-Hunt综合征（THS）;痛性眼肌麻痹;头痛;诊断

[中图分类号] R752.12          [文献标识码] C          [文章编号] 1673-9701（2021）08-0153-03

A case report of Tolosa-Hunt syndrome

HE Wangkai1   XIE Wenjun1  HU Hua2

1.Hu′nan University of Chinese Medicine， Changsha   410208， China; 2.Department I of Encephalopathy， the First Hospital of Hu′nan University of Chinese Medicine， Changsha   410007， China

[Abstract] Tolosa-Hunt syndrome is a disease related to nonspecific inflammation or granuloma in the cavernous sinus segment of internal carotid artery and its nearby endocranium. The main manifestations are intractable pain behind eyeball and around orbit. After a few days of pain， the paralysis of extraocular muscle occurs， and the oculomotor nerve， trochlear nerve and abducent nerve can be all involved. Because of the limitation of biopsy and the sensitivity and specificity of MRI， the diagnosis of THS is relatively difficult. The diagnosis and treatment ideas of painful ophthalmoplegia through case reports were shared， medical history and physical examination were adopted to locate as accurately as possible， and examination was assisted to verify and eliminate related diseases reported in this paper. All the above items could save medical expenses and improve the diagnosis rate of positive lesions as much as possible and reduce misdiagnosis and missed diagnosis. In treatment， efficacies of the integration of traditional Chinese medicine（TCM） and western medicine， treatment based on syndrome differentiation of TCM， and the combination of acupuncture and medicine were emphasized， which could strengthen the body resistance and exorcise evil spirits， reduce the side effects of hormones， improve the symptoms of patients， shorten the course of disease， reduce relapse， regulate the whole body and so on.

[Key words] Tolosa-Hunt syndrome（THS）; Painful ophthalmoplegia; Headache; Diagnosis

Tolosa-Hunt綜合征（THS）又称痛性眼肌麻痹综合征，是临床上少见疾病，病因及发病机制复杂，缺乏敏感的检查手段及特异性好的诊断指标，多数医院由于缺少诊疗经验，易导致误诊、误治、疗效不理想及造成不必要的医疗资源浪费。中医具有经验丰富、治疗手段多样、疗效确切、毒副作用小等特点，且在医疗条件差的地区也可以安全运用，弥补了西医治疗手段单一、副作用多、疗效欠佳等缺点。各地的医疗机构可根据自身情况选择最合适的治疗方法。本文报道了1例我院收治的THS典型病例，呈少见的复发-进展病程，在中医和西医共同的干预下，效果满意，未再复发。……