Painful ophthalmoplegia of the left eye in a 19-year-old female, with an emphasis in Tolosa-Hunt syndrome: a case report

Abstract

IntroductionPainful ophthalmoplegia refers to periorbital or hemicraneal pain plus ipsilateral ocular motor nerve palsies with or without oculo-sympathetic paralysis, sensory loss in the distribution of V1 and V2 can co-occur. There are many etiologies of painful ophthalmoplegia. Tolosa-Hunt syndrome is a steroid-responsive painful ophthalmoplegia secondary to idiopatic granulomatous inflammation of the cavernous sinus or orbital apex. THS is a diagnosis of exclusion and treatment should be with high dose steroid.Case presentationWe describe the case of a 19-year-old female that was admitted to our hospital for painful ophthalmoplegia of the left eye. After the diagnostic work-up, we concluded that the patient had a benign form of Tolosa-Hunt syndrome. We initiated treatment with steroids and 72 hours later saw a response.ConclusionIn conclusion, steroid treatment is the cornerstone in the management of THS. Even though there is no standardized dose specified in the literature, this type of treatment with steroids at a dose of 1 mg/kg/day tapered slowly over 3 to 4 months has been well received.

Painful Ophthalmoplegia of Right Eye in 40-Year-Old Female - Diagnosed As A Case of Tolosa-Hunt Syndrome

“…6 Even though there is no standardize dose specified in the literature, this type of the treatment with steroid at a dose of 1mg/kg/day tapered slowly over three to four months has been well received. 3 …”

“…3,4 Our patient fulfilled all the criteria provided by IHS. She presented within 12 hours of pain onset and she had paresis of IV, V, VI cranial nerves as well as first division of the trigeminal nerve.…”

Unusual case of orbital apex syndrome after chalazion excision

“…Management of orbital apex syndrome is aimed at the underlying cause and may require neurosurgical, otolaryngologic, neurologic or medical consultation. 4 Neuroimaging (preferably magnetic resonance imaging of the brain and orbits with contrast and fat-suppression sequences) is crucial in determining the cause. The distinction between inflammation, infection and neoplasia are often difficult and all may initially respond to corticosteroids.…”

An Interesting Case of Tolosa-Hunt Syndrome in a Young Male

“…It is caused by idiopathic granulomatous inflammation. 2 We present an interesting case of THS in a young male.…”