Serial neuroimaging in tolosa-hunt syndrome with acute bilateral complete ophthalmoplegia.
Tolosa-Hunt syndrome (THS) is a very rare, relapsing, and remitting painful ophthalmoplegia caused by nonspecific granulomatous inflammation in the cavernous sinus. To our knowledge, bilateral complete, simultaneous palsies of all 3 cranial nerves associated with extraocular movement have not been reported. We describe the first such patient with bilateral THS that responded quickly to corticosteroid therapy. A 54-year-old man presented with a periorbital and frontal headache with acute bilateral severe blepharoptosis and fixed eyes, which dramatically responded to corticosteroid therapy. He had diabetes mellitus type II. Brain MRI showed granulomatous inflammation in both cavernous sinuses and thickening of the surrounding dura mater of the cranial base, suggesting the coexistence of focal hypertrophic cranial pachymeningitis. Our experience indicates that steroid therapy with strict control of blood sugar should be considered in patients with THS complicated by diabetes. MRI is a valuable tool for serially monitoring the response of lesions to treatment in THS.
Sugie
Kazuma
K
Department of Neurology, Nara Medical University School of Medicine, Kashihara, Nara, Japan. ksugie@naramed-u.ac.jp
Morikawa
Masami
M
Taoka
Toshiaki
T
Hirano
Makito
M
Ueno
Satoshi
S
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001763:Blepharoptosis / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D002426:Cavernous Sinus / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D012008:Recurrence; D020333:Tolosa-Hunt Syndrome / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones