No abstract available.
Infliximab ; Tolosa-Hunt Syndrome

No abstract available.
Tolosa-Hunt Syndrome*

No abstract available.
Tolosa-Hunt Syndrome*

PURPOSE: To report a case of cavernous sinus dural arteriovenous fistula following Tolosa-Hunt syndrome. CASE SUMMARY: A 64-year-old female with a history of hypertension, presented with blepharoptosis and periorbital pain in the right eye and diplopia. Her right pupil was dilated. She had right exotropia and right hypertropia with inability to elevate, depress, and adduct the right eye. Magnetic resonance imaging including angiography, revealed hyperintensities in the right cavernous sinus consistent with inflammation and no vascular abnormalities. Three days after oral corticosteroid therapy, the pain disappeared. A presumptive diagnosis was Tolosa-Hunt syndrome presenting as a form of complete oculomotor nerve palsy. Two months later, she experienced severe pain in the right periocular area, even though blepharoptosis was resolved and ocular motility was improved. A rapid response to high-dose intravenous corticosteroids was consistent with recurrence of Tolosa-Hunt syndrome. Three months later, she had normal ocular motility, but developed a conjunctival injection, pulsatile orbital bruits, and exophthalmos in the right eye. Cerebral angiography showed a cavernous sinus dural arteriovenous fistula. She received a transvenous coil embolization and her symptoms markedly improved over 2 months. CONCLUSIONS: Tolosa-Hunt syndrome, a granulomatous inflammation in the cavernous sinus may be followed by cavernous sinus dural arteriovenous fistula and should be considered during follow-up.
Adrenal Cortex Hormones ; Angiography ; Blepharoptosis ; Cavernous Sinus* ; Central Nervous System Vascular Malformations* ; Cerebral Angiography ; Diagnosis ; Diplopia ; Embolization, Therapeutic ; Exophthalmos ; Exotropia ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Inflammation ; Magnetic Resonance Imaging ; Middle Aged ; Oculomotor Nerve Diseases ; Orbit ; Pupil ; Recurrence ; Strabismus ; Tolosa-Hunt Syndrome*

Idiopathic hypertrophic cranial pachymeningitis (ICHP) is diffuse inflammatory process of the dura mater. ICHP can produce similar presentation with Tolosa-Hunt syndrome (THS) if it involves cavernous sinus. A-29-year old male with persistent headache and no definite neurologic dysfunction was noted. Two weeks later, he complained of ophthalmoplegia, and his symptoms were thought to be manifestations of THS. Brain magnetic resonance images revealed diffuse thickened, enhanced pachymeninges in left tentorium. The patient was diagnosed with IHCP. We report a IHCP patient who showed very similar presentation as THS.
Brain ; Cavernous Sinus ; Dura Mater ; Headache ; Humans ; Male ; Meningitis* ; Neurologic Manifestations ; Ophthalmoplegia ; Tolosa-Hunt Syndrome*

Alternating recurrent painful ophthalmoplegia is caused by various neurological conditions including Tolosa-Hunt syndrome, sellar mass, and parasagittal meningioma. We experienced a rare case of recurrent painful ophthalmoplegia occurring on the contralateral side as a manifestation of idiopathic hypertrophic tentorial pachymeningitis. We propose that idiopathic hypertrophic pachymeningitis should be considered in the differential diagnosis of alternating recurrent painful ophthalmoplegia.
Diagnosis, Differential ; Meningioma ; Meningitis* ; Ophthalmoplegia* ; Tolosa-Hunt Syndrome

Cavernous sinus syndrome (CSS) is defined as the involvement of two or more of the third, fourth, fifth (V1, V2) or sixth cranial nerves or involvement of only one of them in combination with a neuroimaging-confirmed lesion in the cavernous sinus. Some cases of CSS are attributed to Tolosa-Hunt syndrome (THS), an idiopathic inflammatory disease of the cavernous sinus. THS is characterized by painful ophthalmoplegia due to granulomatous inflammation in the cavernous sinus. THS is a diagnosis of exclusion that requires a vigorous series of differential diagnoses, and corticosteroid therapy is known to dramatically resolve clinical findings of THS. We report a case of a patient with painful ophthalmoplegia associated with vision loss, which was suspected to be THS. This patient followed a relatively typical clinical course of THS on steroid pulse therapy. We emphasize the differential diagnosis of THS, its presentation, and treatment.
Abducens Nerve ; Cavernous Sinus ; Diagnosis ; Diagnosis, Differential ; Headache* ; Humans ; Inflammation ; Ophthalmoplegia ; Tolosa-Hunt Syndrome*

No abstract available.
Cavernous Sinus* ; Central Nervous System Vascular Malformations* ; Tolosa-Hunt Syndrome*

Tolosa-Hunt syndrome is a rare disease caused by non-specific inflammation of the cavernous sinus, superior orbital fissure and the apex of the orbit. It is characterized by ophthalmoplegia, unilateral headache or periorbital pain. Brain magnetic resonance imaging (MRI) usually shows an inflammation of cavernous sinus. It is known that steroid pulse therapy is effective. In this case, we diagnosed a 12-year-old female with Tolosa-Hunt syndrome suffered from left ophthalmoplegia and left sided headache. Her Brain MRI showed mild enlargement of left cavernous sinus. After methylprednisolone pulse therapy and following dexamethasone treatment, her symptoms were markedly improved. In children who suffer from periorbiral pain and ophthalmoplegia, proper brain MRI could be helpful in differential diagnosis including Tolosa-Hunt syndrome.
Brain ; Cavernous Sinus ; Child* ; Dexamethasone ; Diagnosis, Differential ; Eye Pain ; Female ; Headache ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Methylprednisolone ; Ophthalmoplegia ; Orbit ; Rare Diseases ; Tolosa-Hunt Syndrome*

By analyzing the diagnosis and treatment of a patient who suffered from painful ophthalmoplegia and acute rhinosinusitis, authors further identified the clinical features of painful ophthalmoplegia, and the differential diagnosis of those diseases which might cause migraine and ophthalmoplegia to avoid clinical misdiagnosis and mistreatment.
Acute Disease ; Humans ; Male ; Sinusitis ; complications ; Tolosa-Hunt Syndrome ; complications ; Young Adult