J Korean Ophthalmol Soc.  2009 Nov;50(11):1717-1723.

Clinical Observations on Tolosa-Hunt Syndrome

• Lee HK
• Lee SG

Abstract

PURPOSE
The authors reviewed clinical features, response to treatment and recurrence rate of Tolosa-Hunt syndrome.
METHODS
A retrospective chart review was performed on 6 patients, who fulfilled the diagnosis for Tolosa-Hunt syndrome according to the International Headache Society (IHS) classification of 2004.
RESULTS
Every patient had orbital pain as a first symptom, followed by cranial nerve paresis. The third cranial nerve was most commonly involved (83.3%), followed by the sixth nerve (50%), the forth nerve (16.7%), and the first branch of the fifth cranial nerve (16.7%). Two of the patients showed multiple cranial nerve paresis (33.3%, 2 out of 6). All patients received high-dose steroid therapy for more than 5 days, and all patients had resolution of orbital pain within 72 hours of treatment. Full recovery of cranial nerve paresis occurred on average in 2.3 months (3 days to 12 months). During the 29 months of follow-up, 2 patients (33.3%) had a recurrence episode.
CONCLUSIONS
Tolosa-Hunt syndrome responds well to steroid therapy, and full recovery is possible with proper treatment. The exact diagnosis and treatment of Tolosa-Hunt syndrome is important. Because Tolosa-Hunt syndrome often recurs after full recovery, the authors suggest a minimum follow-up period of 2 years.

Keyword

Painful ophthalmoplegia; Tolosa-Hunt syndrome

MeSH Terms

Cranial Nerves
Follow-Up Studies
Headache
Humans
Oculomotor Nerve
Orbit
Paresis
Recurrence
Retrospective Studies
Tolosa-Hunt Syndrome
Trigeminal Nerve

Figure

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  Figure 1. Photograph of case 2 showing ophthalmoplegia and mild ptosis in the left eye.

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  Figure 2. T1-weighted MRI shows a contrast-enhancing lesion with undulated margin and thickening in the left anterior cavernous sinus and superior orbital fissure area (red arrow).

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  Figure 3. Two weeks after steroid pulse therapy of case 2. Periocular pain and ptosis in the left eye disappeared, and left ophthalmoplegia showed much improvement.

Reference

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