title: Steroid-responsive painful ophthalmoplegia: Tolosa-Hunt syndrome, Eales disease, or both?
abstract: Introduction Tolosa-Hunt syndrome (THS) is one of the most common 'benign' causes of painful ophthalmoplegia. Diagnosis is based on clinical and imaging findings and the exclusion of other causes because there is no specific biomarker for the syndrome. Eales disease, an idiopathic inflammatory venous disease that primarily affects the eye, can also affect the central (as stroke or myelitis) and peripheral nervous system. Case report We report the case of a 32-year-old woman with a subacute left ophthalmoplegia and evidence of a gadolinium-enhanced lesion suggesting an inflammatory granuloma that resolved within 48 hours after treatment with steroids. A diagnosis of THS was considered at this time. On a follow-up ophthalmological examination, a diagnosis of Eales disease with involvement of the left eye was made. The patient was treated successfully. Conclusion Eales disease could be a cause of painful ophthalmoplegia and may mimic THS. Long-term follow-up of patients diagnosed with THS may be necessary to exclude other diagnoses.
authors: 1 Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.|2 CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors: Marcelo D
authors: MD
authors: Mendonça
authors: 3 Ophthalmology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors: Marta
authors: M
authors: Guedes
authors: 1 Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors: Gonçalo
authors: G
authors: Matias
authors: 3 Ophthalmology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors: João
authors: J
authors: Costa
authors: 1 Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.|2 CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors: Miguel
authors: M
authors: Viana-Baptista
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D009389:Neovascularization, Pathologic / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D009886:Ophthalmoplegia / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D031300:Retinal Vasculitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D013256:Steroids / Q000627:therapeutic use*; D020333:Tolosa-Hunt Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy
chemical_list: D013256:Steroids
keywords: Eales disease; Tolosa–Hunt syndrome; painful ophthalmoplegia