Painful ophthalmoplegia of the left eye in a 19-year-old female, with an emphasis in Tolosa-Hunt syndrome: a case report
1 Department of Internal Medicine, Calzada de Tlalpan 4800, Colonia Sección XVI, Tlalpan, C.P. 14080. Distrito Federal, México
2 Department of Ophthalmology, Calzada de Tlalpan 4800, Colonia Sección XVI, Tlalpan, C.P. 14080. Distrito Federal, México
3 Department of Neurology, Hospital, Calzada de Tlalpan 4800, Colonia Sección XVI, Tlalpan, C.P. 14080. Distrito Federal, México
Cases Journal 2009, 2:8271 doi:10.4076/1757-1626-2-8271Published: 17 September 2009
Painful ophthalmoplegia refers to periorbital or hemicraneal pain plus ipsilateral ocular motor nerve palsies with or without oculo-sympathetic paralysis, sensory loss in the distribution of V1 and V2 can co-occur. There are many etiologies of painful ophthalmoplegia. Tolosa-Hunt syndrome is a steroid-responsive painful ophthalmoplegia secondary to idiopatic granulomatous inflammation of the cavernous sinus or orbital apex. THS is a diagnosis of exclusion and treatment should be with high dose steroid.
We describe the case of a 19-year-old female that was admitted to our hospital for painful ophthalmoplegia of the left eye. After the diagnostic work-up, we concluded that the patient had a benign form of Tolosa-Hunt syndrome. We initiated treatment with steroids and 72 hours later saw a response.
In conclusion, steroid treatment is the cornerstone in the management of THS. Even though there is no standardized dose specified in the literature, this type of treatment with steroids at a dose of 1 mg/kg/day tapered slowly over 3 to 4 months has been well received.