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Open Access Case Report

Painful ophthalmoplegia of the left eye in a 19-year-old female, with an emphasis in Tolosa-Hunt syndrome: a case report

Juan A Mendez1*, Cristhian R Arias1, Diego Sanchez1, Luis M Pesci2, Brenda S Lopez2, Ruben Lopez2 and Elvira Castro3

Author Affiliations

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

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Cases Journal 2009, 2:8271  doi:10.4076/1757-1626-2-8271

Published: 17 September 2009

Abstract

Introduction

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.

Case presentation

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.

Conclusion

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.