{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:53:32Z","timestamp":1788310412332,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,2,17]],"date-time":"2015-02-17T00:00:00Z","timestamp":1424131200000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Headache"],"published-print":{"date-parts":[[2015,2]]},"abstract":"\n Objective<\/jats:title>\n \n To investigate clinical and radiological features of\n T<\/jats:styled-content>\n olosa\u2013\n H<\/jats:styled-content>\n unt syndrome (\n THS<\/jats:styled-content>\n ) and examine their diagnostic value, and to propose clinical and radiological features that indicate other symptomatic painful ophthalmoplegias (\n SPOs<\/jats:styled-content>\n ) in order to distinguish them from\n THS<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n \n Clinical presentations of\n THS<\/jats:styled-content>\n are nonspecific and may overlap with many etiologies. Therefore, excluding other\n SPOs<\/jats:styled-content>\n is essential for correct diagnosis. At the present time, the predictive value of the current\n I<\/jats:styled-content>\n nternational\n C<\/jats:styled-content>\n lassification of\n H<\/jats:styled-content>\n eadache\n D<\/jats:styled-content>\n isorders (\n ICHD<\/jats:styled-content>\n ) criteria is not well established, and specific imaging markers that can discriminate\n SPOs<\/jats:styled-content>\n from\n THS<\/jats:styled-content>\n are lacking.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Patients referred with painful ophthalmoplegia over 12 years were recruited retrospectively and allocated into\n THS<\/jats:styled-content>\n or\n SPO<\/jats:styled-content>\n groups. Typical symptoms (episodic unilateral orbital pain preceding or developing with diplopia) and imaging of\n THS<\/jats:styled-content>\n (inflammatory lesions in the cavernous sinus\/orbit by magnetic resonance imaging) were proposed based on\n ICHD<\/jats:styled-content>\n \u20103 beta criteria and previous literature. Atypical clinical and radiological features suggesting alternative diagnoses were also proposed to predict\n SPO<\/jats:styled-content>\n . Initial presentations and imaging findings were registered and correlated with diagnostic outcomes. The predictive value of clinical and imaging findings was then evaluated.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 61 referred cases, 25 were classified as\n THS<\/jats:styled-content>\n and 36 as\n SPO<\/jats:styled-content>\n . Of the\n SPO<\/jats:styled-content>\n cases, 52.8% manifested typical\n THS<\/jats:styled-content>\n symptoms at onset. Patients with\n SPOs<\/jats:styled-content>\n were prone to have atypical symptoms (47.2%) and radiographical findings (82.1%) in comparison to those with\n THS<\/jats:styled-content>\n (4.0% and 4.2%, respectively; both\n P<\/jats:italic>\n \u2009<\u2009.001). Both typical symptoms and imaging findings predicted a diagnosis of\n THS<\/jats:styled-content>\n with high sensitivity (95.8% and 100%, respectively) but low specificity (47.2% and 28.6%, respectively). High sensitivity (82.1%) and specificity (95.8%) were achieved using atypical imaging features to predict\n SPO<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n A diagnosis of\n THS<\/jats:styled-content>\n based strictly on clinical presentations or imaging results is not completely reliable. Identification of atypical imaging features may have a useful role in discriminating\n SPOs<\/jats:styled-content>\n and thus avoid erroneous diagnoses of\n THS<\/jats:styled-content>\n . Future studies with larger sample sizes are warranted to evaluate their validity in general population.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/head.12488","type":"journal-article","created":{"date-parts":[[2015,2,17]],"date-time":"2015-02-17T02:06:28Z","timestamp":1424138788000},"page":"252-264","source":"Crossref","is-referenced-by-count":21,"title":["Clinical and Radiological Findings Suggesting Disorders Other Than\n T<\/scp>\n olosa\u2013\n H<\/scp>\n unt Syndrome Among Ophthalmoplegic Patients: A Retrospective Analysis"],"prefix":"10.1111","volume":"55","author":[{"given":"Chih\u2010Hsien","family":"Hung","sequence":"first","affiliation":[{"name":"Department of Neurology Kaohsiung Municipal Hsiaokang Hospital Kaohsiung Taiwan"},{"name":"Department of Neurology Kaohsiung Medical University Hospital; Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Institute of Biomedical Sciences Academia Sinica Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo\u2010Hsuan","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurology Linkou Campus Chang Gung Memorial Hospital and University College of Medicine Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao\u2010Liang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology Keelung Campus Chang Gung Memorial Hospital and University College of Medicine Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Ming","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiology Linkou Campus Chang Gung Memorial Hospital and University College of Medicine Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiou\u2010Lian","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Neurology Kaohsiung Medical University Hospital; Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong\u2010Shiu","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurology Linkou Campus Chang Gung Memorial Hospital and University College of Medicine Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong\u2010Kuo","family":"Lyu","sequence":"additional","affiliation":[{"name":"Department of Neurology Linkou Campus Chang Gung Memorial Hospital and University College of Medicine Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yih\u2010Ru","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurology Linkou Campus Chang Gung Memorial Hospital and University College of Medicine Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiung\u2010Mei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology Linkou Campus Chang Gung Memorial Hospital and University College of Medicine Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin\u2010Chang","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology Linkou Campus Chang Gung Memorial Hospital and University College of Medicine Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Che","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Neurology Linkou Campus Chang Gung Memorial Hospital and University College of Medicine Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Hung","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology Kaohsiung Municipal Hsiaokang Hospital Kaohsiung Taiwan"},{"name":"Department of Neurology Kaohsiung Medical University Hospital; Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long\u2010Sun","family":"Ro","sequence":"additional","affiliation":[{"name":"Department of Neurology Linkou Campus Chang Gung Memorial Hospital and University College of Medicine Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,2,17]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.71.5.577"},{"issue":"3","key":"e_1_2_7_3_1","first-page":"iii29","article-title":"Syndromes of the orbital fissure, cavernous sinus, cerebello\u2010 pontine angle, and skull base","volume":"76","author":"Bone I","year":"2005","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2010.03.011"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102413485658"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102412475238"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2982.2008.01569.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.154.1.2104703"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.53.3.231"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-4610.1999.3905321.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0720-048X(02)00012-8"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2003.09.016"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1673.2008.01988.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2007.11.034"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2982.2006.01115.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-14-7"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.11.1.56"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2009.01405.x"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2009.05.066"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2006.11.001"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A1398"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nec.2012.08.003"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.176.1.1760247"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.72.860.10624338"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2144"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nec.2012.08.004"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2000.92.2.0261"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2171"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(02)01166-1"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2982.1999.tb00056.x"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00602828"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2006.00348_3.x"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6569.2009.00381.x"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-002-1458-3"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-3284-3-32"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00404103"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.rmr.0000224685.83629.18"},{"key":"e_1_2_7_38_1","doi-asserted-by":"crossref","DOI":"10.1055\/b-002-56116","volume-title":"Neuro\u2010Ophthalmology: The Practical Guide","author":"Levin LA","year":"2005"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.15.4.7569130"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.57.3.393"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102413520082"}],"container-title":["Headache: The Journal of Head and Face Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fhead.12488","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.12488","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T09:46:42Z","timestamp":1762076802000},"score":1,"resource":{"primary":{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/10.1111\/head.12488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2]]},"references-count":40,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2015,2]]}},"alternative-id":["10.1111\/head.12488"],"URL":"https:\/\/doi.org\/10.1111\/head.12488","archive":["Portico"],"relation":{},"ISSN":["0017-8748","1526-4610"],"issn-type":[{"value":"0017-8748","type":"print"},{"value":"1526-4610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,2]]}}}