Background: Tolosa Hunt Syndrome is an inflammatory condition of unknown etiology of the cavernous sinus and superior orbital fissure. Because of the difficulty in establishing histological evidence, his diagnosis is ...Background: Tolosa Hunt Syndrome is an inflammatory condition of unknown etiology of the cavernous sinus and superior orbital fissure. Because of the difficulty in establishing histological evidence, his diagnosis is based on a set of arguments established by the International Headache Society. MRI allows indirect visualization of the granuloma and plays a key role in diagnosis and follow-up. Aim: To illustrate High-field MRI contribution in Tolosa-Hunt Syndrome (THS). Cases Presentation: Two patients, a 25-year-old female and a 40-year-old male were recruited in this retrospective case report study at the Radiology service of Fann University Hospital (Dakar Senegal). The first patient has been suffering from a right retro-orbital pain and diplopia for 2 months and the second from a painful oculomotor nerve palsy for 3 months. Blood tests, lumbar puncture, thyroid hormone levels and an infectious screen were done. Screening for converting enzymes, and serum antibodies were also done. They underwent a high field MRI (Siemens 1.5T) with T1, T2, FLAIR, T2*, diffusion B1000, TOF polygon, CISS 3D and T1 gadolinium sequences in the 3 planes space. No significant abnormality was detected in blood tests or CSF analysis. Screening for converting enzymes and serum antibodies screen were also negative. For each patient, MRI examinations showed a non tumoral thickening of the right cavernous sinus, suggesting a granulomatous involvement. Tolosa Hunt Syndrome was evoked firstly. They were put on corticotherapy at high doses with a spectacular regression of symptoms. The Criteria of the International Headache Society of THS were met in both patients. Conclusion: High-field MRI is a significant diagnostic tool in the assessment of painful ophthalmoplegia. It allows a direct visualization of the granuloma of the cavernous sinus and assesses its course throughout the disease.展开更多
Human African Trypanosomiasis (HAT) or sleeping thickness is a forest and rural disease;where agriculture is the main activity. It is a chronic and lethal disease without treatment. HAT is caused by two parasites;Tryp...Human African Trypanosomiasis (HAT) or sleeping thickness is a forest and rural disease;where agriculture is the main activity. It is a chronic and lethal disease without treatment. HAT is caused by two parasites;Trypanosoma Brucei Gambiense (gTB) and Trypanosoma Brucei Rhodesiense (rTB) transmitted to humans by the tsetse fly. It is endemic condition in Africa between the 15° north latitude and the 20° south latitude. It is reported outside this area in travelers who stayed in endemic zone. Infection by gTB is wider and more frequent (98%) than that by rTB (2%). The Democratic Republic of Congo is the most affected country with more than 75% of reported cases. The geographical distribution is not homogeneous. There are more affected regions in a zone called “foci” which represents areas favorable to the development of the vector. Its diagnosis and treatment are very important because of its social and economic impact at both the individual and community levels. Promising molecules including fexinidazole are currently undergoing testing. Nowadays populations move more and more easily but the discovery of this disease in daily neuroradiological practice is exceptional. We propose in this paper through two observations, reminders on epidemiological, clinical and MRI features of HAT. It typically performs the edematous, bilateral and diffuse encephalitis. It is important to distinguish these aspects from the arsenic-induced encephalitis that may occur during treatment. Only vector control allows eradicating this disease. WHO has set targets elimination of HAT as a public health problem for 2020 deadline.展开更多
文摘Background: Tolosa Hunt Syndrome is an inflammatory condition of unknown etiology of the cavernous sinus and superior orbital fissure. Because of the difficulty in establishing histological evidence, his diagnosis is based on a set of arguments established by the International Headache Society. MRI allows indirect visualization of the granuloma and plays a key role in diagnosis and follow-up. Aim: To illustrate High-field MRI contribution in Tolosa-Hunt Syndrome (THS). Cases Presentation: Two patients, a 25-year-old female and a 40-year-old male were recruited in this retrospective case report study at the Radiology service of Fann University Hospital (Dakar Senegal). The first patient has been suffering from a right retro-orbital pain and diplopia for 2 months and the second from a painful oculomotor nerve palsy for 3 months. Blood tests, lumbar puncture, thyroid hormone levels and an infectious screen were done. Screening for converting enzymes, and serum antibodies were also done. They underwent a high field MRI (Siemens 1.5T) with T1, T2, FLAIR, T2*, diffusion B1000, TOF polygon, CISS 3D and T1 gadolinium sequences in the 3 planes space. No significant abnormality was detected in blood tests or CSF analysis. Screening for converting enzymes and serum antibodies screen were also negative. For each patient, MRI examinations showed a non tumoral thickening of the right cavernous sinus, suggesting a granulomatous involvement. Tolosa Hunt Syndrome was evoked firstly. They were put on corticotherapy at high doses with a spectacular regression of symptoms. The Criteria of the International Headache Society of THS were met in both patients. Conclusion: High-field MRI is a significant diagnostic tool in the assessment of painful ophthalmoplegia. It allows a direct visualization of the granuloma of the cavernous sinus and assesses its course throughout the disease.
文摘Human African Trypanosomiasis (HAT) or sleeping thickness is a forest and rural disease;where agriculture is the main activity. It is a chronic and lethal disease without treatment. HAT is caused by two parasites;Trypanosoma Brucei Gambiense (gTB) and Trypanosoma Brucei Rhodesiense (rTB) transmitted to humans by the tsetse fly. It is endemic condition in Africa between the 15° north latitude and the 20° south latitude. It is reported outside this area in travelers who stayed in endemic zone. Infection by gTB is wider and more frequent (98%) than that by rTB (2%). The Democratic Republic of Congo is the most affected country with more than 75% of reported cases. The geographical distribution is not homogeneous. There are more affected regions in a zone called “foci” which represents areas favorable to the development of the vector. Its diagnosis and treatment are very important because of its social and economic impact at both the individual and community levels. Promising molecules including fexinidazole are currently undergoing testing. Nowadays populations move more and more easily but the discovery of this disease in daily neuroradiological practice is exceptional. We propose in this paper through two observations, reminders on epidemiological, clinical and MRI features of HAT. It typically performs the edematous, bilateral and diffuse encephalitis. It is important to distinguish these aspects from the arsenic-induced encephalitis that may occur during treatment. Only vector control allows eradicating this disease. WHO has set targets elimination of HAT as a public health problem for 2020 deadline.
