Tolosa-Hunt Syndrome: Report of a Case

Abstract

Tolosa-Hunt syndrome (THS) is an idiopathic, granulomatous inflammatory disease within the cavernous sinus or superior orbital fissure, which is characterized by painful ophthalmoplegia and dramatic responses of the symptoms to systemic steroid therapy. We present a patient with THS. This 75-Year-old woman suffered from severe retro-orbital pain with III and IV, and impaired pinprick sensation of the first division of the trigeminal nerve in the III and IV, and impaired pinprick sensation of the first division of the trigeminal nerve in the right side. Contrast-enhanced computed tomography of the brain showed only multiple lacunar infarctions over the right side external capsule and basal ganglion, which were not consistent with the clinical symptoms. One gram of methylprednisolone per day was given 8 days after onset of symptoms. Her retro-orbital pain resolved within 48 hours beginning steroid therapy. However, neurological deficits were still noted. Delayed institution of steroid therapy might be the major cause of her neurological sequela. We think steroid therapy should be instituted as soon as possible when THS is suggested. Thorough investigation and long-term follow-up studies are the only methods to confirm the diagnosis of THS.