title: Tolosa-Hunt syndrome with unusual clinical courses--two case reports.
abstract: Two cases of Tolosa-Hunt syndrome with unusual clinical courses are described. The clinical onset of the first patient was typical, but was unresponsive to steroid hormone treatment. The symptoms resolved spontaneously after 1 year. Computed tomography (CT) and magnetic resonance (MR) imaging revealed enlargement of the affected cavernous sinus, which did not change after the symptoms resolved. The clinical presentation in the second patient included marked pupillary dilatation, a sign which is absent in the classical criteria. CT showed no abnormal findings, but MR imaging revealed a mass located in the medial side of the cavernous sinus extending to the lateral wall, which might have caused the pupillary dilatation. After steroid therapy the symptoms disappeared and MR imaging showed remarkable reduction of the mass in the cavernous sinus. Tolosa-Hunt syndrome usually responds promptly to steroid therapy and rarely manifests marked pupillary dilatation. Such variation in presentation adds to the difficulties in diagnosis and treatment of this disease of unknown etiology.
authors.affiliation: Department of Neurosurgery, Fujita Health University School of Medicine, Aichi.
authors.forename: F
authors.initials: F
authors.lastname: Imai
authors.forename: N
authors.initials: N
authors.lastname: Kiya
authors.forename: Y
authors.initials: Y
authors.lastname: Ogura
authors.forename: M
authors.initials: M
authors.lastname: Nomura
authors.forename: K
authors.initials: K
authors.lastname: Gireesh
authors.forename: H
authors.initials: H
authors.lastname: Sano
authors.forename: T
authors.initials: T
authors.lastname: Kanno
mesh_terms: D000328:Adult; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D011239:Prednisolone