Abstract
Tolosa-Hunt syndrome (THS) is an idiopathic, granulomatous inflammation in the cavernous sinus, supraorbital fissure or orbit. Although the pathophysiology of this idiopathic granulomatous inflammatory process is not clear, it has been suggested that cerebrospinal fluid (CSF) analyses could be helpful in understanding the underlying mechanisms. We report two cases of the 3rd Edition of the International Classification of Headache Disorders (ICHD-3)-classified THS who presented with headache and diplopia. After early treatment with intravenous methylprednisolone, the symptoms of two patients were significantly improved. On outpatient follow-up, neither patient had a relapse. It is worth noting that the isoelectric focusing showed identical CSF and serum oligoclonal IgG bands (OBs). Such bands, “mirror pattern bands”, are one of five standardized patterns (i.e., type 1 = absence of bands in serum and CSF; type 2 = presence of OBs in CSF; type 3 = presence of OBs in CSF and additional identical OBs in both serum and CSF, indicative of intrathecal synthesis; type 4 = presence of identical OBs in both serum and CSF, “mirror pattern”; and type 5 = presence of a monoclonal band in serum and CSF). Previous studies have only found OBs in the CSF of THS (type 4). The finding of “mirror pattern bands” is interesting as it reveals an underlying possible systemic immune activation mechanism in THS.
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Abbreviations
- THS:
-
Tolosa-Hunt syndrome
- CSF:
-
Cerebrospinal fluid
- OBs:
-
Oligoclonal IgG bands
- LP:
-
Lumbar puncture
- MRI:
-
Magnetic resonance imaging
- BBB:
-
Blood-brain barrier
- QALB:
-
ALB quotient
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Funding
This study was supported by a grant from the Key Research and Development Program of Ningxia Province of China (2022BEG03130).
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HJH: idea of reporting the case, drafting the manuscript and the figures. RYZ: collection of data, analysis and interpretation of data. QWM: analysis and interpretation of data. YJ: editing of the manuscript in terms of the relevant information and language. LHN: final review of the manuscript and guidance of the authors.
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He, J., Ren, Y., Qi, W. et al. Headache, Ophthalmoplegia, “Mirror Pattern Bands”: Two Case Reports. SN Compr. Clin. Med. 6, 28 (2024). https://doi.org/10.1007/s42399-024-01657-7
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DOI: https://doi.org/10.1007/s42399-024-01657-7