The Tolosa-Hunt syndrome: Further clinical and pathogenetic considerations based on the study of eight cases

Abstract

The Tolosa-Hunt syndrome (THS) is characterized by remittent and sometimes recurring episodes of painful ophthalmoplegia. The etiopathogenesis is still unclear and is an object of controversy. A non-specific granulomatous process of the wall of the cavernous sinus is claimed by many authors as the possible cause, on the basis of a few pathological studies. Other authors suggest the possible role of autoimmune or specific inflammatory processes localized in the retroorbital perineural tissues. The clinical, laboratory and radiological findings of the eight cases reported in the agreement with those previously described in the literature. However, the visual evoked potentials (VEP) were delayed in three of the four cases in which they had been studied. This finding, together with the observation that some analogies exist between THS and other well known neuritic processes of the cranial nerves, may suggest that at least in some cases THS may be related to an ocular polyneuritis.

A Rare Case of Tolosa-Hunt-Like Syndrome in a Poorly Controlled Diabetes Mellitus

“…Optic nerve disturbance is attributed to lesion extension to the orbital apex which contributes to optic disc swelling or pallor [6], thickened optic nerve due to edema [14], and orbital venous congestion [15] that may cause minimal visual decline though variable. In addition to ophthalmoplegia, though infrequent, inflammation extending beyond the cavernous sinus would affect the maxillary [16] and mandibular branch of the trigeminal nerve [17] and the facial nerve [18]. …”

Visusst�rungen beim Tolosa-Hunt-Syndrom

“…Patienten lässt sich im Krankheitsverlauf ein progredienter Visusverlust nachweisen [11]. Der Befall des Sehnervens kann dabei eine Latenzverzögerung der VEP (visuell evozierte Potenziale) wie bei einer demyelinisierenden Nervenschädigung bedingen [8].…”

“…Diese basiert auf einer Mitbeteiligung des N.opticus [11].Auch ohne klinisch fassbare Visusminderung ist in 3 von 4 Fällen eine Latenzverzögerung im VEP nachweisbar. Der Hinweis auf eine demyelinisierende Schädigung des Nerven deutet auf eine häufige, subklinisch verlaufende Mitbeteiligung [8]. …”

“…Neben der konventionellen MRT-Untersuchung zur Darstellung morphologischer Veränderungen des Sinus cavernosus,der Fissura orbitalis superior oder des zisternalen Trigeminussegments [10,18],erfasst die elektrophysiologische Untersuchung mittels VEP sowohl eine klinisch manifeste als auch eine subklinisch verlaufende Mitbeteiligung des N. opticus [8]. Der unspezifische Befund einer Latenzverzö-gerung weist jedoch lediglich auf eine demyelinisierende Schädigung des Nervs hin.…”

NOSOLOGICAL ENTITIES?: The Tolosa-Hunt syndrome

“…These include the maxillary1 6 17 and mandibular branch of the trigeminal nerve,6 23 and the facial nerve 1123 …”