Tolosa-Hunt syndrome responsive to infliximab therapy

Abstract

JO N 3 01 6 cavernous sinus or superior orbital fissure. ESR, serum ACE and neoplastic markers, and CSF examination were normal. MRI scans of brain, including preand post-contrast thin section coronal views of the cavernous sinus and MRI cerebral arteriogram, were normal. CT scanning of thorax and abdomen was normal. A diagnosis of TolosaHunt syndrome was made. The response to two courses of intravenous methylprednisolone (a total of 10 g) resulted in partial (20 %) improvement in her pain but no improvement in the neurological deficit. After three weeks without further improvement, it was decided to begin infliximab therapy. With an infliximab infusion (300 mg – approximately 4 mg/kg) she had good symptomatic pain relief within a few days. At her second course of infliximab four weeks later, her pain and sensory symptoms had entirely resolved, and her diplopia had lessened; she was completely asymptomatic with no abnormal signs after four infusions of infliximab.