Neuro-opthalmological aspect of Tolosa-Hunt Syndrome: A Case Report

Authors

  • V. A. Vasyuta State Institution “Romodanov Neurosurgery Institute of NAMS of Ukraine»
  • Oksana Vitovska Bogomolets National Medical University
  • Tetiana Yovenko State Institution “Romodanov Neurosurgery Institute of NAMS of Ukraine»
  • Svitlana Verbovska State Institution “Romodanov Neurosurgery Institute of NAMS of Ukraine»
  • L. O. Dunaievska State Institution “Romodanov Neurosurgery Institute of NAMS of Ukraine»

DOI:

https://doi.org/10.31288/oftalmolzh202355355

Keywords:

cavernous sinus, fissura orbitalis superior, ocular pain, ocular motility abnormalities

Abstract

Tolosa-Hunt Syndrome is an idiopathic granulomatous inflammatory disease of the cavernous sinus, superior orbital fissure, or orbit which is manifested by ocular pain and ophthalmoplegia. Granulomatous inflammation of the dural wall of the cavernous sinus and/or superior orbital fissure is the basis of the pathological process. The disease is clinically manifested by orbital pain, diplopia, exophthalmos, and/or oculomotor abnormalities. The syndrome is also called painful ophthalmoplegia with a key symptom being neuropathic periorbital or retro-orbital pain, and paresthesias along the first branch of the trigeminal nerve. We present a case of this syndrome. The patient was administered hormonal therapy, Medrol at a daily dose of 1 mg/kg body weight/day intravenously for five days, with subsequent transition within a month to oral Medrol. The pain in the eye completely relieved and restoration of normal ocular motility was observed in the presence of hormonal therapy. Tolosa-Hunt syndrome is a clinical diagnosis of exclusion (i.e., it is diagnosed after excluding other causes of painful ophthalmoplegia).

References

Vasyuta VA, Biloshytsky VV. Differential diagnosis of patients presenting with ocular and periorbital pain: a multidisciplinary approach. J Ophthalmol (Ukraine). 2018;5:66-71.doi: 10.31288/oftalmolzh201856671. https://doi.org/10.31288/oftalmolzh201856671

Kim H, Oh SY. The clinical features and outcomes of Tolosa-Hunt syndrome. BMC Ophthalmology. 2021;21:237. https://doi.org/10.1186/s12886-021-02007-0

Tolosa E. Periarteritic lesions of the carotid siphon with the clinical features of a carotid infraclinoidal aneurysm. J Neurol Neurosurg Psychiatry. 1954;17:300-2. https://doi.org/10.1136/jnnp.17.4.300

Hunt WE, Meagher JN, LeFever HE, Zeman W. Painful ophthalmoplegia. Its relation to indolent inflammation of the cavernous sinus. Neurology. 1961;11:56-62. https://doi.org/10.1212/WNL.11.1.56

La Mantia L, Curone M, Rapaport AM, Bussone G. Tolosa-Hunt syndrome: critical literature review based on IHS 2004 criteria. Cephalalgia. 2006;26(7):772-81. https://doi.org/10.1111/j.1468-2982.2006.01115.x

Colnaghi S, Versino M, Marchioni E, Pichiecchio A, Bastianello S, Cosi V, Nappi G. ICHD-II diagnostic criteria for Tolosa-Hunt syndrome in idiopathic inflammatory syndromes of the orbit and/or the cavernous sinus. Cephalalgia. 2008;28(6):577-84. https://doi.org/10.1111/j.1468-2982.2008.01569.x

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(3):177. https://doi.org/10.1177/0333102417738202

Kim H, Oh SY. The clinical features and outcomes of Tolosa-Hunt syndrome. BMC Ophthalmol. 2021; 21(237):101. https://doi.org/10.1186/s12886-021-02007-0

Kline LB, Hoyt WF. The Tolosa-Hunt syndrome. J Neurol Neurosurg Psychiatri. 2001;71:577-582. https://doi.org/10.1136/jnnp.71.5.577

Olsen K, Johnson A, Castillo S, Bennett J, Ryan MF. Diagnosis and treatment of Tolosa-Hunt Syndrom in the Emergency Department. Open J Emerg Med. 2017;5:1-7. https://doi.org/10.4236/ojem.2017.51001

Zurawski J, Akhondi H. Tolosa-Hunt syndrome--a rare cause of headache and ophthalmoplegia. Lancet. 2013; 382:912. https://doi.org/10.1016/S0140-6736(13)61442-7

Downloads

Published

2023-11-01

How to Cite

1.
Vasyuta VA, Vitovska O, Yovenko T, Verbovska S, Dunaievska LO. Neuro-opthalmological aspect of Tolosa-Hunt Syndrome: A Case Report . J.ophthalmol. (Ukraine) [Internet]. 2023 Nov. 1 [cited 2024 Dec. 3];(5):53-5. Available from: https://ua.ozhurnal.com/index.php/files/article/view/67

Issue

No. 5 (2023): Journal of Ophthalmology (Ukraine)

Section

Case Reports

License

Copyright (c) 2023 Vasyuta V.A., Vitovska O.P., Iovenko T.A., Verbovska S.A., Dunaievska L.O.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

This work is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) that allows users to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author as long as they cite the source.

COPYRIGHT NOTICE

Authors who publish in this journal agree to the following terms:

  1. Authors hold copyright immediately after publication of their works and retain publishing rights without any restrictions.
  2. The copyright commencement date complies the publication date of the issue, where the article is included in.

DEPOSIT POLICY

  1. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) during the editorial process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work with an acknowledgement of its initial publication in this journal.
  3. Post-print (post-refereeing manuscript version) and publisher's PDF-version self-archiving is allowed.
  4. Archiving the pre-print (pre-refereeing manuscript version) not allowed.