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https://doi.org/10.20471/acc.2017.56.02.18

Tolosa-Hunt Syndrome – Case Report

Sandra Zečević Penić ; Sveti Ivan Psychiatry Hospital
Marijana Lisak ; Clinical Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Tomislav Gregurić ; Clinical Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Hrvoje Hećimović ; Neuro Centar, Zagreb, Croatia
Vanja Bašić Kes ; Clinical Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia

Abstract

This case report presents a patient diagnosed with Tolosa-Hunt syndrome (THS) after an extensive neuro-diagnostic and neuroimaging evaluation. Diagnostic work-up included thorough physical and neurological examination, complete laboratory serum assessments, neuroendocrine and immunohistochemistry analysis, cerebrospinal fluid analysis, neurophysiology assessment, ophthalmologist examination and neuroimaging. Th e most important diagnostic tool in deriving the diagnosis of THS was neuroimaging evaluation that included baseline and follow-up cranial contrast enhanced magnetic resonance imaging (MRI). Baseline cranial contrast enhanced MRI detected a nonspecific inflammatory granulomatous lesion in the right cavernous sinus extending basally towards the right trigeminal cave (Meckel‘s cave) and anteriorly towards the apex of the right orbit. Systemic intravenous high-dose corticosteroid therapy was administered for 3 consecutive days and then tapered down to lower oral steroid doses. Following therapy, the patient experienced complete regression of symptoms. Follow-up cranial contrast enhanced MRI showed significant regression of inflammatory lesion in the area of right cavernous sinus, thus verifying the efficacy of the treatment applied. This paper shows that an extensive diagnostic schedule for THS must be conducted prior to therapeutic treatment, for the possibility of alternative diagnosis. Patients suspected of having THS require careful evaluation, appropriate treatment, and follow-up.

Keywords

Tolosa-Hunt syndrome – diagnosis; Tolosa-Hunt syndrome – drug therapy; Magnetic resonance imaging; Adrenal cortex hormones; Case reports

Hrčak ID:

186483

URI

https://hrcak.srce.hr/186483

Publication date:

1.6.2017.

Article data in other languages: croatian

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