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Tolosa-Hunt Syndrome: A Case Report
Siddhanta K C1, Shreeyanta K C2, Prajjwal Kunwar3
1Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal.
JNMA; Journal of the Nepal Medical Association
|September 11, 2021
Summary
Tolosa-Hunt Syndrome causes painful ophthalmoplegia due to inflammation. Prompt steroid therapy significantly improved symptoms in a case study, highlighting its diagnostic importance.
Area of Science:
- Neurology
- Ophthalmology
Background:
- Tolosa-Hunt Syndrome (THS) is a rare condition causing painful ophthalmoplegia.
- It results from idiopathic inflammation in the cavernous sinus or superior orbital fissure, affecting cranial nerves III, IV, and VI.
Observation:
- A 67-year-old female presented with right-sided headache, periorbital pain, and double vision.
- Clinical examination revealed right ptosis, trochlear and abducens nerve palsy, partial oculomotor nerve palsy, and trigeminal nerve hypoesthesia.
- MRI showed signal intensity changes in the optic nerve and lateral rectus muscle.
Findings:
- THS is a diagnosis of exclusion.
- Key diagnostic factors include clinical presentation, normal investigations, specific MRI findings, and a positive response to steroid therapy.
- The patient experienced significant improvement in pain and ptosis within 72 hours of steroid treatment.
Implications:
- Early diagnosis and steroid treatment are crucial for managing Tolosa-Hunt Syndrome.
- This case underscores the importance of considering THS in patients with unexplained painful ophthalmoplegia.
- Further research into the etiology of THS may improve diagnostic accuracy and treatment strategies.
