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Tolosa-Hunt syndrome preceded by facial palsy in a child

Alfredo Cerisola1, Gabriel González, Cristina Scavone

  • 1Department of Pediatric Neurology, Tacuarembó Regional Hospital, Tacuarembó, Uruguay. alfredocerisola@gmail.com

Pediatric Neurology
|December 15, 2010
PubMed

Insights

This study details a rare pediatric case of Tolosa-Hunt syndrome in an 11-year-old boy, presenting with recurrent cranial nerve palsies and headaches. Steroid treatment proved effective, highlighting diagnostic challenges in children.

Area of Science:

  • Neurology
  • Pediatric Neurology

Background:

  • Tolosa-Hunt syndrome (THS) is a rare idiopathic granulomatous inflammation of the cavernous sinus.
  • It typically presents with painful ophthalmoplegia and is characterized by recurrent cranial nerve palsies.

Observation:

  • An 11-year-old boy presented with unilateral periorbital headache and facial nerve palsy.
  • Over five months, he developed recurrent headaches and palsies of the third and sixth cranial nerves, improving with steroids.
  • Cranial MRI showed left cavernous sinus thickening with gadolinium enhancement.

Findings:

  • The patient's recurrent cranial neuropathies, neuroimaging, and steroid-responsive headaches indicated THS.
  • Extensive investigations excluded other causes, confirming the diagnosis.
  • This case represents the first pediatric THS presentation preceded by facial palsy.

Implications:

  • This case underscores the complexity of diagnosing multiple cranial nerve palsies in children.
  • It contributes to the limited literature on pediatric Tolosa-Hunt syndrome.
  • Early recognition and steroid treatment are crucial for managing THS in pediatric patients.

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