Tolosa-Hunt Syndrome: Clinical Case Report

Abstract

Tolosa-Hunt syndrome is a diagnosis of exclusion, with an incidence of 1 or 2 cases per 1 000 000, characterized by the combination of painful ophthalmoplegia and palsy of the III, IV or VI pair of cranial nerves, in the context of idiopathic granulomatous inflammation of the cavernous sinus. The diagnosis is made by the presence of specific clinical and imaging criteria, with corticosteroids being the first-line therapy. The authors describe the clinical case of a 65-year-old male patient who presented with left retroorbital pain, followed by ipsilateral eyelid ptosis and binocular diplopia. The exclusion of other potential causes of painful ophthalmoplegia, the changes identified on magnetic resonance imaging together with the suggestive clinical picture, allowed the diagnosis of Tolosa-Hunt syndrome. The patient was treated with oral prednisolone at a dose of 1 mg/kg/d with complete reversal of the pain symptoms in the first 48 hours. Subsequently, complete resolution of the cranial nerve palsy occurred, as well as partial reversal of imaging changes.