Tolosa-Hunt Syndrome: A Case Report

Tolosa-Hunt Syndrome is a rare disease characterized by painful ophthalmoplegia affecting third, fourth, and/or sixth cranial nerve caused by non-specific inflammation in the cavernous sinus or superior orbital fissure of unknown etiology. We presented a 67-year-old female with Tolosa-Hunt Syndrome. She had a right-sided headache and periorbital pain with double vision. Examination showed right-sided ptosis, right-sided trochlear and abducens nerve palsy, and partial right-sided oculomotor nerve palsy with hypoesthesia in the area of the ophthalmic division of the trigeminal nerve. Magnetic resonance imaging of head and orbit showed altered signal intensity changes in the optic nerve and lateral rectus muscle. After steroid therapy, pain and ptosis were significantly improved in 72 hours. Tolosa-Hunt Syndrome is a diagnosis of exclusion, with clinical presentation, normal investigations, magnetic resonance imaging findings, and response to steroid therapy crucial in making the diagnosis.

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Bilateral facial nerve involvement in a patient with Tolosa–Hunt syndrome

The Neuroradiology Journal ◽

10.1177/1971400920939293 ◽

2020 ◽

Vol 33 (5) ◽

pp. 424-427

Author(s):

Ajay A Madhavan ◽

David R DeLone ◽

Jared T Verdoorn

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Cranial Nerves ◽

Corticosteroid Treatment ◽

Resonance Imaging ◽

Hunt Syndrome ◽

Facial Nerves

Tolosa–Hunt syndrome is characterized by unilateral retro-orbital headaches and cranial nerve palsies, usually involving cranial nerves III–VI. It is rare for other cranial nerves to be involved, although this has previously been reported. We report a 19-year-old woman presenting with typical features of Tolosa–Hunt syndrome but ultimately developing bilateral facial nerve palsies and enhancement of both facial nerves on magnetic resonance imaging. The patient presented with unilateral retro-orbital headaches and palsies of cranial nerves III–VI. She was diagnosed with Tolosa–Hunt syndrome but was non-compliant with her corticosteroid treatment due to side effects. She returned with progressive left followed by right facial nerve palsy. Her corresponding follow-up magnetic resonance imaging scans showed sequential enhancement of the left and right facial nerves. She ultimately had clinical improvement with IV methylprednisolone. To our knowledge, Tolosa–Hunt syndrome associated with bilateral facial nerve palsy and corroborative facial nerve enhancement on magnetic resonance imaging has not previously been described. Moreover, our patient’s clinical course is instructive, as it demonstrates that this atypical presentation of Tolosa–Hunt syndrome can indeed respond to corticosteroid treatment and should not be mistaken for other entities such as Bell’s palsy.

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Surgical Treatment of Cavernous Sinus Cavernomas: Evidence from Vietnam

Reports ◽

10.3390/reports3020016 ◽

2020 ◽

Vol 3 (2) ◽

pp. 16

Author(s):

Duc-Anh Nguyen ◽

Hao The Nguyen ◽

Thang Van Duong ◽

Binh Hoa Pham ◽

Hoang-Long Vo

Keyword(s):

Magnetic Resonance Imaging ◽

Surgical Treatment ◽

Magnetic Resonance ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Tumor Surgery ◽

Resonance Imaging ◽

Radical Removal

Cavernous sinus cavernomas, a rare vascular malformation, represents 3% of all benign cavernous sinus tumors. Both clinical and radiological signs are important for differentiating this condition from other cavernous sinus diseases. The best treatment is radical removal tumor surgery; however, due to the tumor being located in the cavernous sinus, there are many difficulties in the surgery. We report a case of a 35-year-old female who only presented sporadical headache. After serial magnetic resonance imaging acquisitions, a tumor measuring 30 mm in the left cavernous sinus and heterogenous enhencement was observed. Then, the patient underwent an operation with an extradural basal temporal approach. Postoperatively, the tumor was safely gross total removed. The patient developed left oculomotor nerve palsy but fully recovered after 3 months of acupunture treatment, and developed persistent left maxillofacial paresthesia. The surgical treatment for cavernous sinus cavernomas may be considered a best choice regarding safety and efficiency.

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