Diagnostic imaging of Tolosa-Hunt Syndrome: Two rare cases diagnosed at Hanoi Medical University Hospital

  • Nguyen Thu Lan
  • Nguyen Thai Binh
  • Le Viet Dung
  • Le Tuan Linh
Keywords: Tolosa-Hunt syndrome, cavernous sinus, superior orbital fissure, ophthalmoplegia, orbital pain

Abstract

Tolosa-Hunt syndrome is a rare inflammatory process of unknown etiology, affecting the cavernous sinus or/within the superior orbital fissure, with an incidence of 1-2 per million people. Because of the difficulty in establishing histological evidence, his diagnosis is based on a set of criteria established by the International Headache Society. MRI allows indirect visualization of the granuloma and plays a key role in diagnosis and follow-up. We reported two cases with the diagnosis of Tolosa-Hunt syndrome at Hanoi Medical University Hospital. Two patients, a 52-year-old male and a 50-year-old female, came to the hospital because of orbital pain and ophthalmoplegia for 3 months. Blood tests, cerebrospinal fluid, thyroid hormone levels, and screening for infection as well as screening for primary tumors were performed, which showed no abnormality. 1.5T brain MRI in both patients revealed enlarged, non-massive lesions in the ipsilateral cavernous sinus with clinical symptoms, suggesting an inflammatory cause. Tolosa Hunt syndrome is presented after other causes have been ruled out. Both patients responded well to high-dose corticosteroid therapy and did not relapse after 6-8 months of follow-up. Therefore, we have a final diagnosis of Tolosa-Hunt syndrome

Tác giả

Le Tuan Linh

Tolosa-Hunt syndrome is a rare inflammatory process of unknown etiology, affecting the cavernous sinus or/within the superior orbital fissure, with an incidence of 1-2 per million people. Because of the difficulty in establishing histological evidence, his diagnosis is based on a set of criteria established by the International Headache Society. MRI allows indirect visualization of the granuloma and plays a key role in diagnosis and follow-up. We reported two cases with the diagnosis of Tolosa-Hunt syndrome at Hanoi Medical University Hospital. Two patients, a 52-year-old male and a 50-year-old female, came to the hospital because of orbital pain and ophthalmoplegia for 3 months. Blood tests, cerebrospinal fluid, thyroid hormone levels, and screening for infection as well as screening for primary tumors were performed, which showed no abnormality. 1.5T brain MRI in both patients revealed enlarged, non-massive lesions in the ipsilateral cavernous sinus with clinical symptoms, suggesting an inflammatory cause. Tolosa Hunt syndrome is presented after other causes have been ruled out. Both patients responded well to high-dose corticosteroid therapy and did not relapse after 6-8 months of follow-up. Therefore, we have a final diagnosis of Tolosa-Hunt syndrome. 

điểm /   đánh giá
Issue
No. 54 (2024)
Section
Bài viết