Acta Scientific Clinical Case Reports

Case ReportVolume 4 Issue 6

Tolosa Hunt Syndrome in A 45 Year Old Male Presenting as Headache

Joseph Albert Montoya*

Chief Resident, Department of Neurosciences, East Avenue Medical Center, Quezon City, Philippines

*Corresponding Author: Joseph Albert Montoya, Chief Resident, Department of Neurosciences, East Avenue Medical Center, Quezon City, Philippines.

Received: May 02, 2023; Published: May 09, 2023

Abstract

Background: Tolosa Hunt Syndrome is a rare condition caused by an idiopathic inflammation of the cavernous sinus responsive to steroid treatment.

Case Report: A case of a 45 year old previously healthy man whose chief complaint was headache and painful opthalmoplegia. Neurologic examination on admission revealed left ptosis, miotic but reactive pupil, and left ophthalmoplegia. Ophthalmic division of cranial Nerve V revealed an 80% sensory loss. Localization was on the left cavernous sinus. MRI revealed subtle asymmetrical enhancement of the left cavernous signs which is suggestive of inflammation. He was given an oral course of steroids with marked resolution of symptoms after two months with no recurrence after one year on follow up via telemedicine.

Conclusion: The diagnosis of Tolosa hunt was based on clinical grounds. Ancillary testing (other than cranial imaging) returned normal excluding other considerations. This was coupled with exquisite response to steroids. We agree that tissue biopsy remains the standard to make the diagnosis with certainty although not practical for some patients. Surgical biopsy is reserved for symptoms that do not respond promptly to steroids and if they recur after the initial honeymoon period with steroids has lapsed.

Keywords: Tolosa Hunt Syndrome; Etiology; Surgical Biopsy

Bibliography

  1. Iaconetta G., et al. “Tolosa-Hunt syndrome extending in the cerebello-pontine angle”. Cephalalgia 25 (2005): 746.
  2. Amrutkar C and Burton EV. “Tolosa-Hunt Syndrome”. 2020 Aug 10. In: StatPearls. Treasure Island (FL): StatPearls Publishing (2021).
  3. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd Cephalalgia 38 (2018): 1.
  4. Kline LB and Hoyt WF. “The Tolosa-Hunt syndrome”. Journal of Neurology, Neurosurgery and Psychiatry 71 (2001): 577-582.
  5. Zhang X., et al. “Validation of ICHD-3 beta diagnostic criteria for 13.7 Tolosa-Hunt syndrome: Analysis of 77 cases of painful ophthalmoplegia”. Cephalalgia 34 (2014): 624.
  6. Cakirer S. “MRI findings in the patients with the presumptive clinical diagnosis of Tolosa-Hunt syndrome”. European Radiology 13 (2003): 17.
  7. Zhang X., et al. “Factors that influence Tolosa-Hunt syndrome and the short-term response to steroid pulse treatment”. Journal of the Neurological Sciences 341 (2014): 13.

Citation: Joseph Albert Montoya. “Tolosa Hunt Syndrome in A 45 Year Old Male Presenting as Headache". Acta Scientific Clinical Case Reports 4.6 (2023): 14-16.

Copyright: © 2023 Joseph Albert Montoya. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



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