Abstract
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.
Highlights
Tolosa Hunt Syndrome (THS) is an inflammatory granulomatosis of unknown etiology, with a chronic course and which involves the cavernous sinus and the superior orbital fissure
Tolosa Hunt Syndrome is an inflammatory condition of unknown etiology of the cavernous sinus and superior orbital fissure
Diagnosis key of Tolosa-Hunt Syndrome (THS) is based on the histological evidence of inflammatory granuloma
Summary
Tolosa Hunt Syndrome (THS) is an inflammatory granulomatosis of unknown etiology, with a chronic course and which involves the cavernous sinus and the superior orbital fissure. Diagnosis of THS is difficult as evidenced by the evolution of the criteria of the International Headache Society (IHS). These criteria highlight all the difficulty of establishing evidence based diagnosis. Diagnosis key of THS is based on the histological evidence of inflammatory granuloma. Since the initial description by Tolosa, exploration techniques have been significantly improved; this condition is well known nowadays because of advances in medical imaging. We want to discuss through two clinical cases, the clinical findings and MRI contribution of TSH whose treatment is mainly based on corticosteroid therapy
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