Tolosa Hunt syndrome

Case contributed by Dr Dalia Ibrahim

Presentation

Left painful ophthalmoplegia.

Patient Data

Age: 40
Gender: Male
MRI

Intense homogeneously enhancing soft tissue mass lesion is seen at the left anterior cavernous sinus, orbital apex, and superior orbital fissure.

MRI

Four months following steroid therapy.

Significant size regression with near total resolution regrading the previously noted the left anterior cavernous sinus, orbital apex soft tissue mass.

Annotated image

Four months following steroid therapy.

Significant size regression with near total resolution regrading the previously noted left cavernous sinus & orbital apex soft tissue mass.

Case Discussion

The second MRI exam is performed 4 months after steroid treatment, which revealed significant size regression.

The diagnosis in this case is presumptive (by MRI radiological features only), no biopsy was taken.

Tolosa hunt syndrome is a non-specific inflammation of the cavernous sinus and superior orbital fissure.

The  histopathological features of the disease is similar to those of idiopathic orbital pseudotumour; 

Clinical presentation (secondary to cavernous sinus inflammation)

  • Recurrent retro-orbital pain,
  • Palsy of the third, fourth or sixth cranial nerves as well as the first and second divisions of the trigeminal nerve.

Differential diagnosis includes other pathological processes presenting with similar clinical features like Meningioma, Sarcoidosis, Pituitary tumours, tuberculous meningitis, Lymphoma.

The disease is characterized by immediate dramatic response to steroid therapy.

The case is courtesy of Dr Mohamed Fouad, Mohamed Ibrahim & Bahaa Al Din Mahmoud.

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Case information

rID: 29642
Case created: 10th Jun 2014
Last edited: 14th Mar 2016
Inclusion in quiz mode: Included

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