Tolosa-Hunt syndrome following traumatic eye injury.
Summary of "Tolosa-Hunt syndrome following traumatic eye injury."
INTRODUCTION. Tolosa-Hunt syndrome (THS) is an idiopathic condition involving unilateral eye pain with involvement of oculomotor nerves which responds well to treatment with steroids. It is produced by idiopathic granulomatous inflammation of the cavernous sinus or the orbital apex. CASE REPORT. A 37-year-old male who was admitted to hospital due to a six-week history of blurred vision and pain in the left eye, which was later accompanied by full ipsilateral ophthalmoplegia. Some days prior to the onset of the clinical features, he suffered an accident which resulted in traumatic injury to the left eye. An examination showed data pointing to optic neuropathy in the left eye with complete extrinsic ocular motor palsy. Results of general analyses and lumbar puncture were normal. Magnetic resonance imaging (MRI) of the head revealed a thickening of the wall of the left cavernous sinus and of the ipsilateral orbital apex, which enhanced with gadolinium. Evoked potential studies showed axonal and demyelinating optic neuropathy on the left-hand side. Suspecting this to be a case of THS, treatment was established with high doses of corticoids, which brought about an improvement in the pain and eye movement but not in the blurred vision. A MRI control scan showed a clear improvement in comparison to the one carried out initially. CONCLUSIONS. In cases of painful ophthalmoplegia, the professional should suspect the existence of THS. If the apex of the orbit is affected through the superior orbital fissure, the optic nerve may be damaged. Traumatic injury can be one of the situations that trigger THS.
Affiliation
Hospital Infanta Elena, 21007 Huelva, Espana.
Journal Details
This article was published in the following journal.
Name: Revista de neurologia
ISSN: 1576-6578
Pages: 729-33
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22673949
- DOI: http://dx.doi.org/
Medical and Biotech [MESH] Definitions
Tolosa-hunt Syndrome
An idiopathic syndrome characterized by the formation of granulation tissue in the anterior cavernous sinus or superior orbital fissure, producing a painful ophthalmoplegia. (Adams et al., Principles of Neurology, 6th ed, p271)
Head Injuries, Closed
Traumatic injuries to the cranium where the integrity of the skull is not compromised and no bone fragments or other objects penetrate the skull and dura mater. This frequently results in mechanical injury being transmitted to intracranial structures which may produce traumatic brain injuries, hemorrhage, or cranial nerve injury. (From Rowland, Merritt's Textbook of Neurology, 9th ed, p417)
Abducens Nerve Injury
Traumatic injury to the abducens, or sixth, cranial nerve. Injury to this nerve results in lateral rectus muscle weakness or paralysis. The nerve may be damaged by closed or penetrating CRANIOCEREBRAL TRAUMA or by facial trauma involving the orbit.
Coma, Post-head Injury
Prolonged unconsciousness from which the individual cannot be aroused, associated with traumatic injuries to the BRAIN. This may be defined as unconsciousness persisting for 6 hours or longer. Coma results from injury to both cerebral hemispheres or the RETICULAR FORMATION of the BRAIN STEM. Contributing mechanisms include DIFFUSE AXONAL INJURY and BRAIN EDEMA. (From J Neurotrauma 1997 Oct;14(10):699-713)
Central Cord Syndrome
A syndrome associated with traumatic injury to the cervical or upper thoracic regions of the spinal cord characterized by weakness in the arms with relative sparing of the legs and variable sensory loss. This condition is associated with ischemia, hemorrhage, or necrosis involving the central portions of the spinal cord. Corticospinal fibers destined for the legs are spared due to their more external location in the spinal cord. This clinical pattern may emerge during recovery from spinal shock. Deficits may be transient or permanent.
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