Homoeopathic Management in a Rare Case of Tolosa Hunt Syndrome: A Case Report

Abstract

Tolosa Hunt Syndrome is a rare disease often characterized by painful ophthalmoplegia, and severe periorbital headaches which are usually unilateral in presentation, along with features of cranial nerve paralysis such as ptosis, diplopia, facial hypoaesthesia etc. Onset can be seen any age. Although it tagged as a benign condition, but permanent neurologic deficits may occur. Treatment may include use of glucocorticoids or other immunosuppressive therapies according to the standard protocol. A female patient 32 years of age visited National Institute of Homoeopathy OPD presented with complaints of severe left sided headache throbbing in nature since four to five months associated with nausea. The attacks of headache being with very short duration with rising and falling suddenly. She had very plethoric, congestive red facies and complained of dimness of vision of the left eye and of general debility. MRI brain and orbit with IV contrast showed a brilliantly enhancing plaque-like mass lesion measuring 37*18*12mm noted within left orbital apex compressing the orbital contents with extensions also to cavernous sinus and middle cranial fossa compressing adjacent temporal lobe. A detailed case taking was done and based on the totality of symptoms and collaborating with the portrait of disease Belladonna 10M one dose was given followed by rubrum for 1 month. Her paroxysms of headache had considerably decreased with no redness of the face on her first visit. Patient was better with almost no paroxysms of headache for almost five months after first dose then the symptoms reappeared and another dose of Belladonna 10M was repeated on fourthvisit. MRI Brain done almost a year later after commencement of homoeopathic treatment showed the reduction of the lesion upto 17.4mm*11.7*13.7mm seen in the left orbital apex inseparable from lateral rectus and compressing existing optic nerve the lesion extended to the meningeal lining over antero-inferior temporal lobe and parasellar region.MRI result showed significant reduction in the size of the lesion with symptomatic improvement under the homoeopathic treatment with no use of steroids or any other immunosuppressive therapies whatsoever.