title: Unusual clinical course in pediatric Tolosa-Hunt syndrome.
abstract: We report on a 7-year-old immunocompetent boy initially presenting with right-sided frontal cephalalgia, painful ophthalmoplegia, and ptosis for 1 month. Initial cerebrospinal fluid analysis produced normal results. Magnetic resonance imaging revealed an inflammatory pseudotumor of the right cavernous sinus after intravenous gadolinium administration, indicating a rare idiopathic inflammatory disorder of the cavernous sinus, i.e., Tolosa-Hunt syndrome. Ptosis and cephalalgia resolved after steroid treatment, although right-sided ophthalmoplegia remained. Breakthrough headache, associated with signs of meningeal irritation, developed 6 weeks later. Follow-up contrast-enhanced computed tomography revealed no enhancing cavernous soft tissue mass. A further lumbar puncture disclosed central nervous system infection with Staphylococcus saprophyticus. After 6 weeks of vancomycin, the headache resolved completely, and neuroimaging produced normal results. A diagnosis of Tolosa-Hunt syndrome should be rendered cautiously, because the etiology may involve a rare but not "idiopathic" infection. Moreover, if clinical signs are not fully responsive to steroid treatment, the underlying problems should receive careful investigation.
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.
authors.forename: Chia-Hao
authors.initials: CH
authors.lastname: Kang
authors.forename: Yi-Chuan
authors.initials: YC
authors.lastname: Huang
authors.forename: Chun-Chung
authors.initials: CC
authors.lastname: Lui
authors.forename: Ying-Chao
authors.initials: YC
authors.lastname: Chang
authors.forename: Pi-Lien
authors.initials: PL
authors.lastname: Hung
mesh_terms: D002648:Child; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D057790:Staphylococcus saprophyticus; D020333:Tolosa-Hunt Syndrome / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy