Tolosa-Hunt syndrome in a patient with systemic lupus erythematosus

Abstract

We report a case of Tolosa-Hunt syndrome (THS) in a patient with systemic lupus erythematosus studied with MRI. Magnetic resonance showed enlargement of the cavernous sinus and compression of the carotid syphon by enhancing tissue. In particular, fat-suppressed T1-weighted images before and after contrast agent injection and MR angiography showed extension of the abnormal tissue to the apex of the orbit and narrowing of the internal carotid artery. A presumptive diagnosis of THS was made and steroid treatment was started with rapid relief of symptoms. Follow-up MR study after steroid therapy demonstrated sub-total resolution of the neuroradiological findings. Neuroradiological findings in THS are quite typical but they may be subtle; furthermore, the presence of a systemic disease may suggest secondary involvement of the cavernous sinus. Utilization of the appropriate MR techniques and follow-up exams may contribute to the diagnosis of THS even in the presence of other systemic diseases.

Applications of 3D CISS sequence for problem solving in neuroimaging

“…[15] MRI may show only slight enlargement or alteration in the shape of the cavernous sinus, but this is well seen on a CISS sequence [Figure 6]. …”

Tolosa-Hunt Syndrome - Cranial Neuroimaging Findings

“…On the other hand, other causes of painful ophthalmoplegia, including lymphoma, menengioma, craniopharyngioma, paracellar epidermoid cyst, caroticocavernous fistule, thrombosis of the cavernous sinus, giant cell arteritis, systemic lupus erythematosus, diabetic ophthalmoplegia, and ophthalmoplegic migraine, should be excluded by the appropriate methods (10,11,12,13). Also, meningioma and diabetic ophthalmoplegia do not respond to steroid treatment.…”

Idiopathic hypertrophic cranial pachymeningitis masquerading as Tolosa-Hunt syndrome

“…It is important to remember that Tolosa-Hunt syndrome is a constellation of symptoms and signs and has been reported in association with a number of conditions. [30][31][32][33][34][35][36][37][38][39][40][41] proposed that Tolosa-Hunt syndrome might represent a focal manifestation of idiopathic pachymeningitis. 29 Even though our experience is anecdotal, from our experience and from the review of the literature, we feel that the nosologic entity of Tolosa-Hunt syndrome might represent one manifestation of idiopathic hypertrophic cranial pachymeningitis and further studies are required to clarify its aetiology.…”