Among them one patient had Tolosa-Hunt syndrome rather than cavernous sinus involvement (confirmed by MRI).
3 patients had cavernous sinus thrombosis, 3 patients had Tolosa-Hunt syndrome, 1 patient had a Lepra reaction and 1 patient had ophthalmoplegic migraine.
Brainstem Multiple sclerosis Mass lesion: tumor, cavernous malformation Infection including herpes Infarct Syringobulbia Cisternal space and Neurovascular conflict (the most common cause Meckel's cave of trigeminal neuralgia) Mass in the cisterns: schwannoma, meningioma, epidermoid Leptomeningeal process: carcinomatosis, lymphoma, leukemia, sarcoidosis, meningitis Skull base mass: chordoma, chondrosarcoma, multiple myeloma, osseous metastasis Gradenigo syndrome Cavernous sinus Neoplasms: schwannoma, meningioma, pituitary macroadenoma, lymphoma, nasopharyngeal carcinoma, metastatic disease Tolosa-Hunt syndrome
Infection Carotid-cavernous aneurysm/fistula Extracranial space Perineural spread of head and neck neoplasm Peripheral nerve sheath tumor
Keywords: Diagnosis, dynamic contrast MRI, Tolosa-Hunt protocol, Tolosa-Hunt syndrome
Tolosa-Hunt Syndrome (THS) is a rare disorder characterized by periorbital or hemicranial pain, ipsilateral oculomotor paralysis, and prompt response to steroids.
(THS) is a painful, usually unilateral ophthalmoparesis or ophthalmoplegia caused by nonspecific inflammation (granulomatous or nongranulomatous) of the cavernous sinus or superior orbital fissure.
: the pathology of painful ophthalmoplegia.
Painful ophthalmoplegia is the consequence of the mass effect on the cavernous sinus which includes trauma, vascular malformation, neoplasm, infection, and inflammation including Tolosa-Hunt syndrome
, Wegener's granulomatosis, or orbital pseudotumor .
After hospitalization, corticosteroid was administered on suspicion of Tolosa-Hunt syndrome
(1) The condition was termed Tolosa-Hunt syndrome
by Smith and Taxdal in 1966.
Lymphoma of the cavernous sinus mimicking Tolosa-Hunt syndrome
in a child.
Thyroid eye disease, orbital pseudotumours, Tolosa-Hunt syndrome
can also be included in the differential diagnosis of CCF.
The differential diagnosis of idiopathic OM includes the following: infections (viral infections, orbital cellulitis, orbital abscess, Lyme disease, Herpes zoster, and syphilis), inflammatory reaction (trauma, foreign body, bisphosphonaterelated reaction, and postvaccinal reaction), Tolosa-Hunt syndrome
, thyroid ophthalmopathy, vasculitis (Wegener's granulomatosis, polyarteritis nodosa, rheumatoid arteritis, giant cell arteritis, and Kawasaki disease), systemic lupus erythematosus, sarcoidosis, inflammatory bowel disease, neoplasm, arteriovenous fistulas, and malformations (3).
(THS) is a rare disorder characterized by severe unilateral headaches with multiple cranial nerve palsies, usually involving the third, fourth, fifth, and sixth cranial nerves and periorbital pain, along with weakness and paralysis of extra ocular muscles.
DISCUSSION: Tolosa-Hunt syndrome
(THS) is a rare disorder characterized by severe and unilateral headaches with extra ocular palsies, usually involving the third, fourth, fifth, and sixth cranial nerves, and pain around the sides and back of the eye, along with weakness and paralysis (ophthalmoplegia) of certain eye muscles (1).