Bilateral visual loss in the Tolosa-Hunt syndrome

Abstract

This paper describes a 65-year-old man with Tolosa-Hunt syndrome who presented with unilateral painful ophthalmoplegia and bilateral visual loss.Cranial CT scan revealed an enhancing mass at the right superior orbital fissure and optic canal but a biopsy showed only chronic inespecific inflammation. Treatment with corticosteroid resulted in marked improvement although ODe eye rem ained blind. The inflammatory process involved the right superior orbital fissure and optic nerve and presumably extended across the skull base to involve the contralateral optic nerve.

Disappearing diplopia - An unusual presentation of Tolosa-Hunt syndrome: A case report

“…Optic nerve involvement in THS is uncommon [5,6]. This is an indication of orbital apex involvement.…”

“…Our patient's initial contrast CT being normal, he was discharged with a diagnosis of idiopathic IV nerve palsy. Although Gadolinium enhanced contrast MRI is the imaging modality of choice [1,6], it is considered less specific in the context of THS [1]. We are unable to say if an MRI would have shown evidence of inflammation if done at first presentation.…”

“…We commenced our patient on oral prednisolone and the patient achieved complete clinical resolution. Follow up of these patients is important as neoplasms can have a positive response to steroids initially but may recur subsequently [5,6]…”