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Humphrey's treasure hunt trouble
\"Humphrey is spending the weekend at Garth's house when the prize for his scavenger hunt is stolen from its hiding place in Humphrey's cage.\"-- Provided by publisher.
Book
Clinical characteristics of Tolosa-Hunt syndrome in patients with diabetes mellitus
Background
Diabetes mellitus (DM), a globally prevalent metabolic disease, affects the nervous system through multiple mechanisms, leading to cranial neuropathies. Tolosa-Hunt syndrome (THS) is a rare disorder that, when occurring in diabetic patients, may present with clinical manifestations that overlap with diabetic cranial neuropathy (DCN), increasing the risk of misdiagnosis and delaying corticosteroid treatment. This study aims to systematically analyze the clinical characteristics of THS in diabetic patients and explore optimal management strategies.
Methods
This study conducted a retrospective analysis, integrating data from previously published cases and cases diagnosed at our center. Inclusion criteria were based on the diagnostic standards for THS outlined in the ICHD-3, while cases with other potential causes of headache and ophthalmoplegia were excluded. Data collected included baseline characteristics, clinical manifestations, treatment regimens, and therapeutic outcomes. Statistical analysis was performed using Fisher’s exact test, t-test, and Wilcoxon rank-sum test.
Results
A total of 19 cases of diabetes-associated THS were included (11 males, 8 females), with males presenting at a significantly younger age than females (
P
= 0.041). All patients experienced severe headaches, 89.47% had ptosis, 94.73% exhibited ophthalmoplegia, and 15.79% presented with facial sensory disturbances. Eight patients were initially misdiagnosed with DCN and received neurotrophic therapy without improvement, but they responded rapidly to corticosteroid treatment. All patients showed significant symptom improvement within six days of corticosteroid administration. Methylprednisolone and dexamethasone demonstrated therapeutic effects comparable to prednisone, though symptom resolution was slightly delayed in the prednisone group.
Conclusion
The clinical features of diabetes-associated THS include severe headache, ptosis, and ophthalmoplegia, which can be easily confused with DCN. Corticosteroid therapy demonstrated high efficacy in this cohort. Clinicians should consider the possibility of THS in diabetic patients presenting with ptosis and ophthalmoplegia to avoid misdiagnosis and ensure timely corticosteroid treatment, thereby improving patient outcomes.
Journal Article
Catch that cookie!
Marshall refuses to believe that gingerbread men can run, even after a series of clues leads his class on a riddle-filled gingerbread cookie hunt.
BOOK
Review of Tolosa-Hunt Syndrome, Recent Updates
Purpose of Review
We aim to present diagnostic considerations and management insights on Tolosa-Hunt syndrome. We highlight recent controversies in this field and emerging literature.
Recent Findings
The diagnostic categorization of Tolosa-Hunt syndrome remains controversial, with imaging negative cases described in the literature and an increasing literature of secondary causes falsely diagnosed as Tolosa-Hunt syndrome. Response to steroids can fulfill diagnostic criteria, but newer management strategies are available in treatment-resistant patients, such as steroid-sparing agents or radiotherapy.
Summary
Tolosa-Hunt syndrome has become controversial; the entity of granulomatous inflammation of the cavernous sinus and possible extension into orbital fissure and posterior orbit of late has been re-evaluated. Recent case series and reviews have outlined multiple false positive (neoplasm or infection) and negative (no imaging findings) diagnoses. In the future, when assessing whether a patient has this entity, we caution readers to closely follow patients for secondary causes and consider this entity in differential even if MRI is non-revealing. Additionally, biopsy should be regarded as a gold standard for diagnosis and utilized, especially in uncertain cases. The diagnostic categorization of Tolosa-Hunt syndrome may need reconsideration in future versions of the ICHD.
Journal Article
The last laugh of âEdouard Bresson
\"To his fans, âEdouard Bresson is the greatest comic standing--charismatic, adored, unmatched, and aiming ever higher for the unpredictable. To his ex-wife, he fulfilled all expectations, except as a husband and a lover. To his brother, he's a hero. And to his estranged son, Arthur, he's always been a mystery. Never more so than now ...after the performance of a lifetime at the sold-out Stade de France, âEdouard decides to vanish. Trلes drمole. Arthur isn't laughing. âEdouard has sent him a letter and instructions to a puzzle--a treasure hunt for the son he ignored and misses and loves. If Arthur is willing to find out everything there is to know about his father and to understand the choices he made, all he has to do is put the pieces together. As the trail of clues winds its way through the past--reflected in the memories of both father and son--what unfolds is a surprising journey of forgiveness, family, and self-discovery\"--Amazon.com.
Book
Pirate school
At Pirate School, Pete learns to act like a pirate and fight it out, but when he and a classmate find the treasure at the same time, pirate rules don't seem to work.
Book
The evaluation of ICHD-3 beta diagnostic criteria for Tolosa–Hunt syndrome: a study of 22 cases of Tolosa–Hunt syndrome
The objective of the study was to evaluate the amended International Classification of Headache Disorders (third edition, beta version, ICHD-3 beta) with a retrospective analysis. A total of 22 patients diagnosed with painful ophthalmoplegia and Tolosa–Hunt syndrome (THS) in our hospital were retrospectively studied. The following clinical data were collected: symptoms, signs, location of inflammatory tissue, time interval of paresis following the onset of pain, pain and signs of resolution, follow-up and relapse. Pain and diplopia were found in 22 (100 %) and 20 cases (91 %). The sympathetic nerve was involved in 6 cases (27 %). Paresis followed the pain for an average of 8 ± 5.87 days. Serial magnetic resonance imaging (MRI) revealed granulomatous lesion that was visible in 20 patients (91 %). 19 patients (86 %) demonstrated the lesions located in the cavernous sinus, orbital apex or superior orbital fissure. One lesion extended to the intracranial structure. Pain was relieved in 20 cases (91 %) within 72 h and no patient had complete relief from paresis. According to our study, we think the time course of relief should be undefined. Headache location is hard to describe accurately. Normal MRI should be involved in THS diagnoses. The lesion of THS can extend beyond the cavernous sinus and the orbit. The time interval between headache and paresis can exceed 2 weeks.
Journal Article