Tolosa–Hunt syndrome presenting during pregnancy following progesterone administration

Abstract

authors contributed equally. Funding InformationShandong Province Science and Technology Development Plan K E Y W O R D S : Aortic dissection; Pregnancy; Triple-branched stent graft A woman aged 36 years at 36 weeks of pregnancy sought medical attention at the Shandong Provincial Hospital affiliated to Shandong University, Shandong, China, after experiencing acute chest pain. The patient was diagnosed with chronic hypertension, severe preeclampsia, acute aortic dissection, aortic regurgitation, and heart failure. Computed tomography examination demonstrated a DeBakey type I aortic dissection that involved the origin of the innominate artery, the left common carotid artery, and the left subclavian artery. Cardiotocography monitoring revealed no obvious fetal anomalies; this was thought to result from the relatively normal uterine-placental arterial supply that was unaffected by aortic dissection. The patient underwent cesarean delivery with hysterectomy and relevant cardiovascular treatment 3 days after admission. A median sternotomy was performed under general anesthesia and total cardiopulmonary bypass was established. Subsequently, the attending obstetrician performed the cesarean delivery and hysterectomy.

The diagnostic dilemma of a pregnant woman presenting with an isolated sixth nerve palsy: A case report

“…Her MR imaging showed enhancement of the superior cavernous sinus and she had progressive recovery after treatment with prednisolone. 8 The sixth nerve with its long subarachnoid course reflects changes due to the rise in intracranial pressure. It can be the result of stretching of the nerve in its long course, or compression against the petrous ligament or the ridge of the petrous temporal bone.…”

“…Her MR imaging showed enhancement of the superior cavernous sinus and she had progressive recovery after treatment with prednisolone. 8…”

“…The literature is limited to case reports/series regarding isolated sixth nerve palsy in pregnancy. [2][3][4][5][6][7][8][9] We report a case of a woman with preeclampsia in her third pregnancy, who developed an isolated sixth nerve palsy and was found to have aseptic cavernous sinus thrombosis.…”

Tolosa Hunt Syndrome: Current Diagnostic Challenges and Treatment

“…Similarly, among the pregnant women THS presents with headache, nausea and diplopia unilaterally, the incidence has been linked to recent increased tendency of progesterone supplementation for the spontaneous abortion and pre-mature deliveries avoidance, the mechanism behind being the immune modulation outcomes of pregnancy moderated by progesterone and estrogen by expressing angiogenic factors in the inflamatory tissue and lower the apoptosis of granulomatous cells [46].…”

Tolosa-Hunt syndrome relapse during pregnancy following chronic intake of combined oral contraceptives

“…It has an estimated incidence of nearly one to two cases per million per year and is ultimately a diagnosis of exclusion 2. While its aetiology remains unknown, few reports in the literature have documented its dysimmune pathogenesis influenced by pregnancy and pregnancy-related hormones 3 4…”