A comparison of benign and inflammatory manifestations of Tolosa-Hunt syndrome

Hung, Chih-Hsien; Chang, Kuo‐Hsuan; Wu, Yi-Ming; Chen, Yao-Liang; Lyu, Rong‐Kuo; Chang, Hsun-Yun; Wu, Yih‐Ru; Chen, Chiung‐Mei; Huang, Chin‐Chang; Chu, Chun‐Che; Liao, Ming‐Feng; Wai, Yau‐Yau; Hsu, Shih‐Pin; Ro, Long‐Sun

doi:10.1177/0333102412475238

Cited by 34 publications

(48 citation statements)

References 32 publications

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“…There is not sufficient evidence for the appropriate dose, route of administration and duration of therapy 12. A remarkable feature of glucocorticoid therapy is the rapid resolution of the orbital pain within 1–3 days, which also serves as diagnostic confirmation 10 13. Our patient responded in a similar manner.…”

Section: Discussionsupporting

confidence: 74%

Tolosa-Hunt syndrome: an arcane pathology of cavernous venous sinus

et al. 2015

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Tolosa-Hunt syndrome, an idiopathic granulomatous inflammation of the cavernous sinus, is primarily a diagnosis of exclusion. The majority of patients present with unilateral orbital pain and features suggestive of paralysis of one or more of the cranial nerves passing through the cavernous sinus and/or superior orbital fissure. MRI of the head may show unilateral enhancement of the cavernous sinus and orbital apex. Treatment is with high-dose intravenous steroids followed by tapering oral steroids. Rapid amelioration of pain within 24–48 h supports this rare diagnosis. Resolution of neuropathies may take longer. We describe a case of a young man who presented with left periorbital pain, complete ophthalmoplaegia and ptosis of the left eye. MRI showed enhancement of the left cavernous sinus and orbital apex. High dose steroids led to complete resolution of pain, while ptosis and ophthalmoplaegia improved gradually.

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Section: Discussionsupporting

confidence: 74%

Tolosa-Hunt syndrome: an arcane pathology of cavernous venous sinus

et al. 2015

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“…However, other conditions such as lymphoma, sarcoidosis, and meningioma can have similar findings and the clinician must keep these in mind when interpreting MRI results [2,5,39,40]. Infrequently, the MRI can be normal in patients with THS [9,12,33,38,[41][42][43]. In this study, MRI demonstrated cavernous sinus enhancement in all patients whose initial MRI was normal.…”

mentioning

confidence: 53%

Evaluation and Management of Tolosa–Hunt Syndrome in Children: A Clinical Update

Pérez

Evangelista

2016

Pediatric Neurology

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“…An initial prednisolone dose of 1.0 to 1.5 mg/kg/day is commonly found in available reports. However, the therapeutic effect reportedly does not differ between doses above and below 0.5 mg/kg/day [14]. The patient in this case was an elderly man of small stature; consequently, there were concerns over adverse reactions to corticosteroid therapy, and dose modulation was required.…”

Section: Discussionmentioning

confidence: 79%

A case of delirium in Tolosa-Hunt syndrome during corticosteroid therapy

Ishikawa

Kubota

et al. 2018

JA Clin Rep

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Background: Corticosteroid therapy is useful for the resolution of pain and paresis in Tolosa-Hunt syndrome; however, there is no definitive protocol for appropriate dosing, route of administration, or duration of therapy. Steroid psychosis is an adverse reaction to corticosteroid therapy; in severe cases, it can develop into psychiatric disorders such as delirium, depression, and mania. In this case study, we report a patient with Tolosa-Hunt syndrome who developed delirium while receiving corticosteroid therapy. Case presentation: The patient was a 70-year-old man being treated for a main complaint of pain in the right eye accompanied by oculomotor paralysis. We suspected Tolosa-Hunt syndrome based on diagnostic imaging and other findings. Steroid pulse therapy was initiated with intravenous methylprednisolone at 1000 mg/day for 3 days, followed by oral prednisolone at 60 mg/day. The pain in the right eye disappeared the day after starting this regimen, and palpebral ptosis also improved. However, 5 days after starting treatment, the patient developed progressively worsening delirium, which was considered an adverse reaction to the steroid pulse therapy. Then, prednisolone treatment was temporarily suspended, and the delirium subsequently disappeared. Conclusions: The manifestation of steroid psychosis following corticosteroid therapy is dose dependent. Therefore, corticosteroid therapy for elderly patients requires caution and dose modulation because of likely adverse drug reactions.

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A comparison of benign and inflammatory manifestations of Tolosa-Hunt syndrome

Abstract: Benign and inflammatory THS were highly similar in terms of nosography. The responses to glucocorticoid treatment were generally good except in patients with orbital pseudotumors.

Cited by 34 publications

References 32 publications

Tolosa-Hunt syndrome: an arcane pathology of cavernous venous sinus

Tolosa-Hunt syndrome: an arcane pathology of cavernous venous sinus

Evaluation and Management of Tolosa–Hunt Syndrome in Children: A Clinical Update

A case of delirium in Tolosa-Hunt syndrome during corticosteroid therapy

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