A Painful Ophthalmoplegia- Tolosa Hunt Syndrome: A Case Report

Abstract

Tolosa-Hunt Syndrome is an uncommon condition characterized by painful ophthalmoplegia affecting the third, fourth, and/or sixth cranial nerves, which is caused by an unknown etiology of non-specific inflammation in the cavernous sinus or superior orbital fissure. a 60-year-old diabetic male patient who recovered from covid-19, 15 days before, came with complain of sharp and intense unilateral headache, ptosis, ophthalmoplegia and loss of vision in right eye in the past 10 days diagnosed with Tolosa-Hunt Syndrome was presented. He was suffering from a right-sided headache, periorbital pain, and double vision. Right-sided ptosis, right-sided trochlear and abducens nerve palsy, and partial right-sided oculomotor nerve palsy with hypoesthesia in the ocular division of the trigeminal nerve were discovered during the examination. The optic nerve and lateral rectus muscle revealed abnormal signal intensity variations on magnetic resonance imaging showed the minimal proptosis noted on the right side with mild edema in the right periorbital soft tissues and small enhancing soft tissue in the right cavernous sinus region which suggested the possibility of Tolosa Hunt Syndrome of the head and orbit. Pain and ptosis were greatly reduced after 72 hours of steroid treatment. Tolosa-Hunt Syndrome is an exclusionary diagnosis with a clinical presentation, normal tests, and magnetic resonance imaging. Recurrent unilateral orbital pain, ipsilateral oculomotor paralysis, and a quick reaction to steroids characterize Tolosa–Hunt syndrome, a severe ophthalmoplegia Treated with intravenous methyl prednisolone (40 mg) once a day with other supportive care therapy. Yet, there was no reversal of vision loss and ptosis. However, the headache subsided and the patient was discharged after 7 days. In Vadodara, Gujarat, India this is most likely the first occurrence and reported case of Tolosa–Hunt syndrome.