Diagnostic and management challenges of patients with recurrent tolosa hunt syndrome

Abstract

Tolosa Hunt Syndrome (THS) includes painful ophthalmoplegia with periorbital or hemicranial pain, ipsilateral ocular motor nerve palsies, oculosympathetic paralysis, and sensory loss in the distribution of the ophthalmic and occasionally the maxillary division of the trigeminal nerve. The pathology is usualy localised to the region of the cavernous sinus/superior orbital fissure and may be usually due to trauma, neoplasm, aneurysm, and inflammation. Rarely patients may present with a relapsing and remitting course. Comprehensive patient evaluation is essential in establishing the correct diagnosis. Management is usually with systemic corticosteroid therapy and sometimes immunosuppression (IS) may be warranted. In this abstract we aim to present cases with recurrent THS and further discuss management strategies and diagnostic challenges. Case series: We would like to report 3 patients (2 females, ages between 36 and 45) with recurrent THS. The relapse ocurred within the first year after the initial presentation and patients were all treated with high dose steroids and IS (azaotioprine). Patients have been relapse free with IS and slow corticosteroid tapering. THS is a diagnosis of exclusion and careful diagnostic approach is warranted.