Shortlasting, Unilateral, Neuralgiform Headache Attacks With Conjunctival Injection and Tearing (SUNCT Syndrome): V. Orbital Phlebography

We studied six patients with SUNCT, a unilateral headache syndrome with shortlasting attacks and ipsilateral autonomic phenomena with orbital phlebography and MRI. All but one orbital phlebogram showed abnormalities on the headache side (in one patient bilaterally), involving the superior ophthalmic vein or/and the cavernous sinus. No systematic changes were demonstrated on MRI. The phlebography findings were similar to those observed in the Tolosa-Hunt syndrome and in cluster headache.

Orbital varix with a pearly phlebolith

✓ A patient is described with an orbital varix arising from the right superior ophthalmic vein, associated with ophthalmoplegia and severe pain, and without proptosis. The varix was detected using computerized tomography and orbital phlebography, and at surgery was verified as a venous aneurysm. During the operation, a pearly phlebolith was found. Histological examination of the varix revealed multiple ectatic venous channels. The etiology of this unusual clinical manifestation and the treatment of the patient are briefly discussed.

Orbital Phlebography for Differentiation between Multiple Sclerosis and Venous Vasculitis in Subacute Blindness

Thirteen consecutive patients with subacute unilateral loss of vision and periorbital pain but without pathology of the fundus or increased erythrocyte sedimentation rate, were investigated with visual evoked response, electrophoresis of serum and cerebrospinal fluid, and orbital phlebography. Seven of these patients were found to suffer from multiple sclerosis. The remaining 6 were considered to have venous vasculitis. There was a spontaneous recovery from visual impairment in all patients with multiple sclerosis, but not in patients with venous vasculitis. Of the latter patients, only two, who were treated with steroids within the first four days after onset of symptoms, regained vision. It appears that orbital phlebography is the diagnostic procedure of choice for proper management of patients with subacute loss of vision.