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Recurrent Tolosa-Hunt syndrome.

Phyo-Wai Thu1, Yu-Ming Chen1, Weng-Ming Liu1,2

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Summary

Tolosa-Hunt syndrome (THS) can recur and may not respond well to initial steroid treatment. This case highlights a unique presentation involving different cranial nerves with each painful ophthalmoplegia episode.

Keywords:
Cranial neuropathyDifferential diagnosisPainful ophthalmoplegiaTolosa–Hunt syndromeTreatment

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Area of Science:

  • Neurology
  • Ophthalmology

Background:

  • Tolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia due to granulomatous inflammation.
  • It is typically responsive to glucocorticoid therapy.

Observation:

  • A 48-year-old female presented with recurrent THS.
  • Initial episodes showed a poor response to low-dose steroids.
  • Subsequent episodes involved different cranial nerves, presenting with painful ophthalmoplegia.

Findings:

  • Neuroimaging revealed enhancement in the right cavernous sinus.
  • The patient required glucocorticoid pulse therapy and azathioprine for management.
  • This case demonstrates a steroid-refractory THS with atypical recurrence patterns.

Implications:

  • THS may present with variable responses to standard glucocorticoid treatment.
  • Recurrent THS can involve diverse cranial nerve deficits.
  • Management strategies may need to be individualized for refractory cases.