Meningioma presenting as Tolosa-Hunt syndrome.
A 23-year-old woman was admitted with headache, nausea, vomiting and blurred vision on the left side. Neurological examination showed ptosis with a complete internal and external ophthalmoplegia and a red fullness around the left orbita. Computed tomographic scanning of the brain revealed no abnormalities. As she improved on high doses of steroids a diagnosis of Tolosa-Hunt syndrome (THS) seemed to be indicated. However, magnetic resonance imaging (MRI) showed a lesion with intermediate signal intensity in the left cavernous sinus. Craniotomy was performed when symptoms of THS recurred. Histopathological examination revealed a meningioma with a papillary aspect and some mitoses. This case illustrates that: (1) THS is still a diagnosis by exclusion; (2) MRI and histopathological examination are important if there is any doubt about the diagnosis; and (3) also when there is no doubt, improvement after steroid therapy may be a diagnostic pitfall. Therefore, not only MRI but also orbital phlebography and angiography should seriously be considered.
Leijzer
C T
CT
Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands.
Prevo
R L
RL
Hageman
G
G
D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D003287:Contrast Media; D003399:Craniotomy; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006406:Hematoma / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008579:Meningioma / Q000150:complications / Q000473:pathology* / Q000628:therapy; D009361:Neoplasm Invasiveness; D009886:Ophthalmoplegia / Q000175:diagnosis* / Q000209:etiology; D010254:Paranasal Sinus Diseases / Q000175:diagnosis; D012658:Sella Turcica / Q000473:pathology / Q000528:radiation effects / Q000601:surgery
D003287:Contrast Media; D019786:Gadolinium DTPA