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Recurrent Tolosa-Hunt syndrome with normal neuroimaging. A report of three cases

P.E. Jiménez-Caballero, J. Florensa, C. Marsal-Alonso, A. Álvarez-Tejerina [REV NEUROL 2005;41:30-33] PMID: 15999327 DOI: https://doi.org/10.33588/rn.4101.2004652

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Volumen 41 | Number 01 | Nº of views of the article 19.841 | Nº of PDF downloads 1.232 | Article publication date 01/07/2005

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ABSTRACT

INTRODUCTION Tolosa-Hunt syndrome is caused by an unspecific inflammation in the cavernous sinus or superior orbital fissure. Recurrence occurs in 40% of cases. Magnetic resonance (MR) of the head and orbital phlebography can reveal characteristic data, although diagnosis is reached by exclusion according to International Headache Society criteria. Corticoids are the preferred treatment, since their use gives rise to the disappearance of the clinical condition in a few days.

CASE REPORT We describe the cases of three patients with recurrent Tolosa-Hunt syndrome and MR images of the head with normal contrast. Case 1: a 52-year-old male with paralysis of the oculomotor nerve with recurrence on the contralateral side. Case 2: a 42-year-old female with recurrent paralysis of the abducent nerve. Case 3: a 34-year-old male with involvement of the oculomotor nerve, optic nerve and the first branch of the trigeminal nerve with recurrence of the ophthalmoplegia. In all cases the clinical symptoms disappeared with the use of corticoid therapy.

CONCLUSIONS The oculomotor disorder is produced by nerve infiltration and not by compression. The time for recurrence varies largely, and the clinical condition in the recurrence is usually milder owing to the fact that diagnosis is reached and treatment is started earlier. The absence of alterations in the MR of the head does not rule out the existence of Tolosa-Hunt syndrome, even in cases of recurrence, and these disorders therefore should not be included in the diagnostic criteria. KeywordsCavernous sinus Granulomatous inflammation Magnetic resonance imaging of the head Painful ophthalmoplegia Recurrence Tolosa-Hunt syndrome CategoriesDolor Neuroimagen

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Nota Clínica

Recurrent Tolosa-Hunt syndrome with normal neuroimaging. A report of three cases