title: Tolosa-Hunt syndrome: an arcane pathology of cavernous venous sinus.
abstract: Tolosa-Hunt syndrome, an idiopathic granulomatous inflammation of the cavernous sinus, is primarily a diagnosis of exclusion. The majority of patients present with unilateral orbital pain and features suggestive of paralysis of one or more of the cranial nerves passing through the cavernous sinus and/or superior orbital fissure. MRI of the head may show unilateral enhancement of the cavernous sinus and orbital apex. Treatment is with high-dose intravenous steroids followed by tapering oral steroids. Rapid amelioration of pain within 24-48 h supports this rare diagnosis. Resolution of neuropathies may take longer. We describe a case of a young man who presented with left periorbital pain, complete ophthalmoplaegia and ptosis of the left eye. MRI showed enhancement of the left cavernous sinus and orbital apex. High dose steroids led to complete resolution of pain, while ptosis and ophthalmoplaegia improved gradually.
authors: Department of Internal Medicine, Hamad Medical Corporation, Weill Cornell University, Doha, Qatar.
authors: Adeel
authors: A
authors: Arshad
authors: Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA.
authors: Shahzaib
authors: S
authors: Nabi
authors: Weill Cornell Medical College in Qatar, Ar-Rayyan, Qatar.
authors: Muhammad Siyab
authors: MS
authors: Panhwar
authors: Department of Internal Medicine, Hamad Medical Corporation, Weill Cornell University, Doha, Qatar.
authors: Ali
authors: A
authors: Rahil
mesh_terms: D000328:Adult; D001763:Blepharoptosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D002426:Cavernous Sinus / Q000473:pathology*; D003391:Cranial Nerves / Q000473:pathology*; D003937:Diagnosis, Differential; D005157:Facial Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009886:Ophthalmoplegia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D009915:Orbit / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use*; D020333:Tolosa-Hunt Syndrome / Q000150:complications / Q000175:diagnosis* / Q000473:pathology
chemical_list: D013256:Steroids