scholarly journals Tolosa-Hunt Syndrome: A Case Report and Review of the Literature

2013 ◽  
Vol 29 (2) ◽  
pp. 130-133
Author(s):  
Md Rafiqul Islam ◽  
Hasan Zahidur Rahman ◽  
Akm Anwar Ullah ◽  
Md Amir Hossain ◽  
- Md Ziauddin
Keyword(s):  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Cranial Nerve ◽  
Motor Nerve ◽  
Pathological Process ◽  
Sensory Loss ◽  
Oral Steroid ◽  
Superior Orbital Fissure ◽  
Hunt Syndrome ◽  
Cranial Nerve Palsies

Tolosa-Hunt Syndrome is a painful ophthalmoplegia which is characterized by periorbital or hemicranial pain, with ipsilateral ocular motor nerve palsies, oculosympathetic paralysis, sensory loss in the distribution of the ophthalmic and occasionally the maxillary division of the trigeminal nerve. Various combinations of these cranial nerve palsies may occur, localising the pathological process to the region of the cavernous sinus/superior orbital fissure. We report the case of a patient presented with severe pain in the right side of face which was periorbital with ipsilateral 3rd,4th, 6th cranial nerve palsies along with ophthalmic and maxillary division of trigeminal nerve involvement. MRI of orbit showed hypo-intense lesion in right cavernous sinus extending to right superior orbital fissure (suggestive of granulomatous infiltration). After taking oral steroid her pain was relieved quickly and cranial nerve palsies reversed within one week. Azathioprin was added and she was completely cured of within next three months. Bangladesh Journal of Neuroscience 2013; Vol. 29 (2) : 130-133

scholarly journals A Rare Case of Tolosa-Hunt-Like Syndrome in a Poorly Controlled Diabetes Mellitus

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Glenmore Lasam ◽  
Sakshi Kapur
Keyword(s):  
Diabetes Mellitus ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Rare Case ◽  
Tight Glycemic Control ◽  
Eighth Cranial Nerve ◽  
Diagnostic Investigation ◽  
Hunt Syndrome ◽  
Cranial Nerve Palsies ◽  
The Right

We report a case of a 50-year-old female with diabetes mellitus who presented with progressive second, third, fifth, sixth, and eighth cranial nerve palsy. Diagnostic investigation revealed hyperglycemic state, and brain imaging showed a right cavernous sinus enhancement suggestive of and consistent with Tolosa-Hunt syndrome. The patient was started on steroids with tight glycemic control for eight weeks; subsequently, the cranial nerve palsies resolved as well as documented resolution of the right cavernous sinus enhancement.

Syndromes of the Orbital Apex, Superior Orbital Fissure, and Cavernous Sinus

2019 ◽  
pp. 213-218
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Clinical Features ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Surgical Debridement ◽  
Antifungal Treatment ◽  
Orbital Apex ◽  
Superior Orbital Fissure ◽  
Cranial Nerve Palsies ◽  
Common Causes ◽  
Timely Fashion

Lesions in the orbital apex, superior orbital fissure, and cavernous sinus can give rise to characteristic combinations of cranial nerve palsies. In this chapter, we begin by reviewing the clinical features and common causes of syndromes of the orbital apex, superior orbital fissure, and cavernous sinus. We go on to discuss the pathogenesis and clinical features of rhino-orbital mucormycosis in detail, because it has a grave prognosis if it is not diagnosed and treated in a timely fashion. We then describe the roles and importance of imaging and tissue biopsy for its diagnosis. Lastly, we review the management of rhino-orbital mucormycosis, which includes rapid reversal of predisposing factors (such as diabetic ketoacidosis), immediate initiation of empiric antifungal treatment, and early surgical debridement of infected tissue.

Cranial Nerves Three, Four, Six, and Their Syndromes

2014 ◽  
pp. 162-206
Author(s):  
Shirley H. Wray
Keyword(s):  
Diabetes Mellitus ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Pituitary Tumors ◽  
Oculomotor Nerve ◽  
Hunt Syndrome ◽  
Cranial Nerve Palsies ◽  
Aberrant Regeneration ◽  
Oculomotor Nuclear Complex

is the longest chapter in the book and perhaps the most important. Syndromes of the oculomotor nuclear complex, the fasciculus and the nerve[BluM2] include disorders such as acute dilation of the pupil due to uncal herniation, aneurysmal compression of the nerve with pupil involvement or with pupil sparing, and microinfarction of the nerve with pupil sparing due to ischemia associated diabetes mellitus. Important syndromes of the sphenocavernous sinus characterized by painful ophthalmoplegia are generally associated with multiple unilateral cranial nerve palsies. Common lesions include aneurysms, meningiomas, pituitary tumors, lymphoma, and infectious and idiopathic granulomatous infiltration (the Tolosa-Hunt syndrome). A patient with primary aberrant regeneration of the oculomotor nerve due to prolonged compression by a meningioma in the cavernous sinus is illustrated by video display.

Syndromes of the Orbital Apex, Superior Orbital Fissure, and Cavernous Sinus

2011 ◽  
pp. 169-174
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak ◽  
Robert B. Daroff
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Orbital Apex ◽  
Superior Orbital Fissure ◽  
Cranial Nerve Palsies ◽  
Timely Fashion

Lesions in the orbital apex, superior orbital fissure, and cavernous sinus can give rise to characteristic combinations of cranial nerve palsies. In this chapter, we briefly review the possible causes of these syndromes. We discuss rhino-orbital mucormycosis in detail, because it has a grave prognosis if it is not diagnosed and treated in a timely fashion.

scholarly journals Painful Ophthalmoplegia of Right Eye in 40-Year-Old Female - Diagnosed As A Case of Tolosa-Hunt Syndrome

2016 ◽  
Vol 24 (2) ◽  
pp. 160-162
Author(s):  
Umma Salma ◽  
Nurul Amin Khan ◽  
Mohammad Abdus Sattar Sarker ◽  
Shamsun Nahar ◽  
Rowsan Ara
Keyword(s):  
Cavernous Sinus ◽  
Superior Orbital Fissure ◽  
Painful Ophthalmoplegia ◽  
Medical College ◽  
Hunt Syndrome ◽  
Unilateral Headache ◽  
Nonspecific Inflammation

Tolosa-Hunt Syndrome (THS) is a painful opthalmoplegia caused by nonspecific inflammation of cavernous sinus or superior orbital fissure. Here, we present a case of THS who presented with severe unilateral headache and opthalmoplegia, responded dramatically with systemic steroidJ Dhaka Medical College, Vol. 24, No.2, October, 2015, Page 160-162

Delayed Cranial Nerve Palsy After Coiling of Carotid Cavernous Sinus Aneurysms

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. E1215-E1216 ◽  
Author(s):  
David S. Xu ◽  
Michael C. Hurley ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Clinical Presentation ◽  
Cranial Neuropathy ◽  
Aneurysm Neck ◽  
Post Procedure ◽  
Cranial Nerve Palsies ◽  
Endovascular Coils ◽  
Healthy Females

Abstract OBJECTIVE Detachable endovascular coils have become a common treatment strategy for carotid cavernous sinus aneurysms (CCAs), but previously unrecognized postprocedure complications may emerge as longer follow-up data are accumulated. In this report, the authors document the first known cases of delayed cranial neuropathy following CCA coiling in 3 patients, all of whom present at least a year postprocedure without aneurysm regrowth. The potential mechanisms underlying this syndrome are discussed as well as their implications on the selection and optimal endovascular management of CCA patients. CLINICAL PRESENTATION Three previously healthy females aged 50, 60, and 62 underwent CCA coiling at our institution and subsequently developed ipsilateral cranial nerve palsies at 56, 28, and 14 months, respectively, post-procedure. At presentation, all 3 patients had a new, recurrent area of flow in their CCA without changes in aneurysm size. INTERVENTION One patient declined further treatment. In the other 2 patients, a stent was placed across the aneurysm neck, and one patient underwent additional coiling. Unfortunately, all 3 patients remained symptomatic at their latest follow-up. Conclusion Because of the intimate anatomic environment of the cavernous sinus, neural elements within it may be particularly susceptible to persistent mass or dynamic effects exacerbated by remnant or recurrent flow across the neck of a coiled aneurysm. These 3 cases prompted the authors to advocate for more aggressive efforts to achieve and maintain CCA occlusion. Furthermore, when such efforts are unsuccessful, consideration of traditional carotid occlusion strategies with or without bypass is warranted.

scholarly journals Ophthalmoplegia and cranial nerve deficits in an adolescent with headache

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110244
Author(s):  
Margarita M Corredor ◽  
Peter J Holmberg
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Signs And Symptoms ◽  
Inflammatory Condition ◽  
Cranial Nerve Involvement ◽  
Hunt Syndrome ◽  
Nerve Involvement ◽  
Orbital Pain

Tolosa–Hunt syndrome is an idiopathic, inflammatory condition involving the cavernous sinus and is characterized by unilateral, painful ophthalmoparesis. The condition often begins with retro-orbital pain followed by select cranial nerve involvement. We report the case of a 17-year-old female whose presentation with progressive left-sided headache and ophthalmoparesis culminated in the diagnosis of Tolosa–Hunt syndrome. While many of her signs and symptoms have been previously reported in the rare pediatric cases of Tolosa–Hunt syndrome described in the literature, this case illustrates a unique presentation involving cranial nerves V and VII in addition to the more commonly reported cranial nerve III, IV, and VI palsies.

Transsphenoidal approach to infrasellar tumors involving the cavernous sinus

1990 ◽  
Vol 73 (4) ◽  
pp. 513-517 ◽  
Author(s):  
Nobuo Hashimoto ◽  
Haruhiko Kikuchi
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Transsphenoidal Approach ◽  
Skull Base Tumors ◽  
Content Type ◽  
Operating Field ◽  
Cranial Nerve Palsies ◽  
Operative Complications ◽  
Fine Print

✓ The authors review their 2-year experience with a rhinoseptal transsphenoidal approach to skull-base tumors of various pathologies involving both the sphenoid and cavernous sinuses. Eight patients with cranial nerve palsies attributable to compression of the contents of the cavernous sinus and/or optic canal are included in this report. Among these patients, a total of 17 cranial nerves were affected. Postoperative normalization was achieved in eight nerves, significant improvement in seven nerves, and no improvement in two nerves. There were no operative complications of aggravation of cranial nerve palsies in this series. In spite of the limited operating field, the results demonstrate the effectiveness and safety of this approach. The authors recommend that this approach be considered before more aggressive surgery is undertaken.

scholarly journals Tolosa-Hunt syndrome relapse during pregnancy following chronic intake of combined oral contraceptives

2021 ◽  
Vol 14 (1) ◽  
pp. e238944
Author(s):  
Bernadeth Lyn Cal Piamonte ◽  
Keno Lorenzo Ong ◽  
Alvin Rae Cenina
Keyword(s):  
Cavernous Sinus ◽  
Oral Contraceptives ◽  
Granulomatous Inflammation ◽  
Spontaneous Remission ◽  
Superior Orbital Fissure ◽  
Combined Oral Contraceptives ◽  
Painful Ophthalmoplegia ◽  
Hunt Syndrome ◽  
History Of ◽  
The Relationship

Tolosa-Hunt syndrome (THS) is a rare syndrome of painful ophthalmoplegia secondary to an idiopathic granulomatous inflammation affecting the cavernous sinus, superior orbital fissure or orbit. Pregnancy and pregnancy-related hormones have been identified as potential triggers. A 39-year-old gravida-2 para-1 woman with prior chronic intake of combined oral contraceptives (COC) suffered two episodes of painful ophthalmoplegia—the first event with spontaneous remission and the relapse occurring during pregnancy and with complete resolution following steroid treatment. MRI revealed a postinflammatory mass at the junction of the left orbital apex and anterior cavernous sinus, supporting the diagnosis of THS. To our knowledge, this is the first report of a THS relapse occurring during pregnancy following a chronic history of COC intake. This case adds to the growing evidence supporting the relationship between immune and hormonal factors that may be present during pregnancy and the disease pathogenesis of THS.

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