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

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Cases Journal

, 2:8271

First Online: 17 September 2009Received: 13 June 2009Accepted: 04 September 2009DOI: 10.4076-1757-1626-2-8271

Cite this article as: Mendez, J.A., Arias, C.R., Sanchez, D. et al. Cases Journal 2009 2: 8271. doi:10.4076-1757-1626-2-8271


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.

AbbreviationsADAadenosine deaminase

ANAantinuclear antibody

ANCAanti-neutrophil cytoplasmic antibodies

CSFcerebrospinal fluid

CTcomputerized tomography

ERemergency room

IHSinternational headache society

MRAmagnetic resonance angiography

MRImagnetic resonance imaging

NSAIDnon-steroidal anti-inflammatory drugs

PCRpolymerase chain reaction

TSHTolosa-Hunt syndrome.

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Autor: Juan A Mendez - Cristhian R Arias - Diego Sanchez - Luis M Pesci - Brenda S Lopez - Ruben Lopez - Elvira Castro


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