Study on the clinical manifestation and imaging examination of Tolosa-Hunt syndrome

Study on the clinical manifestation and imaging examination of Tolosa-Hunt syndrome
Author(s): HU Jue, ZHAO Zhihong, ZHOU Junjie, Department of neurology, Changsha centre hospital
Journal: Journal of Apoplexy and Nervous Diseases, Year 2015 , Issue 7 , Page 623-626
Keyword:  Tolosa-Hunt syndrome; Cavernous sinus; Magnetic resonance imaging;
Abstract: Objective To study the clinical manifestation,imaging examination and treatment of Tolosa-Hunt syndrome in order to improve the diagnosis and treatment level in clinical practice. Methods The clinical manifestation,laboratory examination,treatment and prognosis datas of twelve cases with Tolosa-Hunt syndrome were retrospectively reviewed.Results Most of the cases were onset subacutely. Paresis coincided with the onset of pain in two cases. Paresis followed the onset of pain within 14 d in ten cases. Nine cases developed oculomotor paralysis. Six cases developed abducens nerve paralysis. Two cases developed trochlear nerve paralysis. Two cases had involvement of optic nerve. Blood routine,blood sedimentation,cerebrospinal fluid pressure and routine and biochemical analysis were almost normal. MRI showed the increase in the size of the cavernous sinus due to abnormal soft tissuce lesion in 12 cases and the abnormal soft tissuce lesion extended to superior orbital fissure in 4 cases. The lesion showed marked enhancement after intravenous gadolinium. All cases had good response to corticosteroid therapy. Pain were relieved within 10 ~ 72 hours after initiation of corticosteroid therapy. Signs were resoloved within 4 ~ 60 d after initiation of corticosteroid therapy in 11 cases. Sequela of cranial nerve paralysis was found in one case. Conclusion Paresis may coincides with the onset of pain or follows it within 14 d in cases with Tolosa-Hunt syndrome. The laboratory examination were was lack of specific suggestion for diagnose. MRI of cavernous sinus plays a pivotal role to diagnose. The condition is exquisitely sensitive to corticosteroid therapy. The time to reach signs resolution is longer than pain resolution.

 
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