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

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.

Painful ophthalmoplegia due to involvement of cavernous sinus region by malignant neoplasm: report of three cases

Context: Intracranial tumor spread is an infrequent and late manifestation of head and neck cancers. We report three cases of painful ophthalmoplegia due to larynx and parotid neoplastic involvement. Data disclosure was authorized by the patients through an Informed Consent Form. Case reports: A 47-year-old man presents right retro- orbital pain and progressive ophthalmoplegia 5 months after resection of laryngeal spinocellular carcinoma and local radiotherapy. A 44-year-old man, 9 months after excision of spinocellular carcinoma of the larynx and subsequent radiotherapy, presents severe pain and paralysis of the left CN VI. Imaging exams showed involvement of CS. A 67-year-old woman with a tumoral mass in the left preauricular region. Biopsy revealed adenocarcinoma of the parotid gland. After total parotidectomy, the supra-omohyoid cervical ganglion was removed. Patient received radiotherapy for 3 months. Then, she presented a frontal and right temporal headache, more intense in the retro-orbital region. After one month, she developed complete CS syndrome, with the right CN VI being the first to be affected. MRI revealed an irregular enhancement lesion in right CS after contrast administration. All patients died despite treatment. Conclusions: In patients with painful ophthalmoplegia, the most common hypotheses are diabetic neuropathy and Tolosa-Hunt syndrome. CS involvement may be the first evidence of a distant head and neck disease. Despite the poor prognosis, palliative care should be considered.

Tolosa–Hunt Syndrome: A Painful Ophthalmoplegia

Tolosa–Hunt syndrome is a painful ophthalmoplegia characterized by recurrent unilateral orbital pain, ipsilateral oculomotor paralysis, and a rapid response to steroids. Our report describes a 37-year-old young woman who presented with right ptosis, ipsilateral ophthalmoplegia, and painful headache with no other neurological deficits in which all biological and neuroimaging investigations were normal. Complete recovery within one week of corticosteroid therapy was observed. This is probably the first case of Tolosa–Hunt syndrome reported in Dakar, Senegal.

Clinical Features of Painful Ophthalmoplegia with a High-Intensity Ring Appearance around the Optic Nerve on MRI: A Case Series

Objective. Painful ophthalmoplegia includes nonspecific magnetic resonance imaging (MRI) manifestations and various clinical features including orbital pain and cranial nerve palsies. Treatment for painful ophthalmoplegia remains controversial. The aim of this report was to describe detailed clinical features, MRI findings, treatments, and prognosis of patients with painful ophthalmoplegia. Patients and Methods. We retrospectively investigated four cases of patients with painful ophthalmoplegia diagnosed using the International Classification of Headache Disorders, 3rd edition. Results. All patients experienced unilateral orbital pain and oculomotor nerve palsy with diplopia but no vision loss. One of the four patients was diagnosed with Tolosa–Hunt syndrome based on the appearance of a granulomatous inflammation of the cavernous sinus on MRI. No specific lesions were detected on brain MRI for the other three patients; therefore, their headaches were attributed to ischaemic ocular motor nerve palsy. In all patients, a high-intensity ring appearance around the ipsilateral optic nerve was observed on MRI. Steroid therapy was administered to these patients, and good prognoses were anticipated. Conclusion. These results indicate that prednisolone is a useful treatment for painful ophthalmoplegia that displays ipsilateral hyperintense ring lesions around the optic nerve on MRI, regardless of the presence of granulomatous inflammation of the cavernous sinus.