Tolosa Hunt syndrome: a rare syndrome

Tolosa Hunt Syndrome: Increased Severity on Second Attack

“…The disease is manifested by recurrent periorbital pain, headaches on the same periorbital side and diplopia. Clinical signs include slight exophthalmos, extra ocular palsies involving the third, fourth, and sixth cranial nerves and numbness in the area of V1 and V2 branch of the trigeminal nerve [2,3].…”

“…THS is usually reported as unilateral, with no predilection to right or left cavernous sinus, While 4.1-5% of THS is bilateral [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Uniformly, patients complain of pain, which is a defining symptom.…”

“…The 3rd nerves is involved in 85% of cases, the 6th nerve in 70%, the ophthalmic branch of 5th nerve in 30% and the 4th nerve in 29% [4]. Sympathetic innervation of the pupil is occasionally affected [3]. Facial palsy in not uncommon and systemic symptoms, as back pain, arthralgia, chronic fatigue and gastrointestinal upset, are also noted [5,6].…”

“…Facial palsy in not uncommon and systemic symptoms, as back pain, arthralgia, chronic fatigue and gastrointestinal upset, are also noted [5,6]. Clinically, painful ophthalmoplegia and immediate response to steroid therapy are a hallmark of the condition [3]. The aetiology is unknown, although it shares histopathological features with idiopathic orbital pseudo-tumor.…”

“…The aetiology is unknown, although it shares histopathological features with idiopathic orbital pseudo-tumor. However, owing to its anatomical location, it produces characteristic clinical manifestations [1,3]. Over the years, there have been cases reporting the involvement of cranial nerves outside the cavernous sinus [7][8][9][10], and some authors raised the possibility that the syndrome is in fact part of a larger spectrum of idiopathic recurrent cranial neuropathy [9,11].…”