Tolosa-Hunt syndrome in a young female: a case report

Abstract

Purpose: Tolosa-Hunt syndrome (THS) is a rare steroid-responsive etiology for painful ophthalmoplegia. Our purpose is to present an interesting case of THS in a young female.
Case report: A 17 year old female consulted due to severe frontal headache and left-sided periorbital pain, with the left eyelid ptosis and diplopia. Visual acuity was 20/20 in each eye. Intraocular pressure, anterior segment and fundus examination was normal in both eyes. Ocular movement was restricted to adduction in left eye with painful movements, upper left-sided eyelid ptosis and partial left-sided oculomotor cranial nerve palsy. Laboratory tests were within normal limits and a cranial multi-slice computed tomography was reported normal. Magnetic resonance imaging was performed: the brain and the orbits are described as signal isointense on T2 weighted scans in left transverse sinus. On the basis of history and imaging, a diagnosis of THS was made and the patient was started on corticosteroid therapy (methylprednisolone, 1 g IV for 3 days), and a dramatic improvement in diplopia and pain was noted within 48 hours of starting steroid therapy. After 6 weeks of oral prednisolone a full remission of the condition was attained.
Conclusion: THS is a diagnosis which is managed and follow-up by several specializations (emergency physicians, neurologists, neurosurgeons, ophthalmologists and otolaryngologists). The data regarding the disease course and scarce, thus reporting new cases are very important.anagement remain