Tolosa Hunt Syndrome

Abstract

The Tolosa-Hunt syndrome (THS) is an infrequent condition where the third, fourth, and/or sixth cranial nerves are affected by painful ophthalmoplegia due to non-specific inflammation in the cavernous sinus or superior orbital fissure, of an unknown etiology. THS has a yearly estimated incidence of one case per million people. A 60-year-old male patient with diabetes, who had recently recovered from COVID-19, reported experiencing severe unilateral headache, ptosis, ophthalmoplegia, and vision loss in his right eye for the last 10 days. The patient was diagnosed with Tolosa-Hunt Syndrome, presenting with right-sided headache, periorbital pain, and double vision. Upon examination, he was found to have right-sided ptosis, right-sided trochlear and abducens nerve palsy, and partial right-sided oculomotor nerve palsy with hypoesthesia in the ocular division of the trigeminal nerve. Magnetic resonance imaging demonstrated little proptosis on the right side, as well as modest edema in the right periorbital soft tissues and a tiny enhancing soft tissue in the right cavernous sinus region, implying Tolosa-Hunt Syndrome of the head and orbit. Steroid treatment provided relief from pain and ptosis within 72 hours, but there was no reversal of vision loss. The patient was discharged after 7 days with the headache subsiding. This case appears to be the first reported occurrence of Tolosa-Hunt Syndrome in Vadodara, Gujarat, India. Tolosa-Hunt Syndrome is diagnosed based on clinical presentation, normal tests, and magnetic resonance imaging and is treated with intravenous methylprednisolone (40 mg) once a day and other supportive care therapy. The syndrome is characterized by recurrent unilateral orbital pain, ipsilateral oculomotor paralysis, and a quick response to steroids.