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Tolosa-Hunt syndrome with reversible dissection aneurysm
Zhiming Zhou1, Guangyi Zhou, Tingting Lu
1Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, Jiangsu, China.
Summary
Tolosa-Hunt syndrome (THS) caused nerve injuries and vascular lesions in a patient. Steroid treatment resolved symptoms and healed the dissection and stenosis, suggesting inflammation as the cause.
Area of Science:
- Neuro-ophthalmology
- Vascular Neurology
Background:
- Tolosa-Hunt syndrome (THS) is a rare condition characterized by painful ophthalmoplegia.
- It is often associated with inflammation of the cavernous sinus and superior orbital fissure.
Observation:
- A 49-year-old female presented with a 4-month history of right retro-orbital pain, ptosis, and diplopia.
- Neurological examination revealed right oculomotor and abducent nerve palsies.
- Neuroimaging demonstrated an enlarged right cavernous sinus with an intracavernous carotid dissection aneurysm and proximal stenosis.
Findings:
- The patient was diagnosed with THS and treated with corticosteroids.
- Clinical symptoms significantly improved following steroid administration.
- Follow-up cerebral angiography after 3 months showed near-complete resolution of the carotid dissection and stenosis.
Implications:
- This case suggests that inflammation in THS can directly induce intracavernous carotid artery dissection and stenosis.
- The findings highlight the importance of considering THS in patients with painful ophthalmoplegia and associated vascular abnormalities.
- Prompt diagnosis and treatment of THS with steroids can lead to favorable vascular and neurological outcomes.
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