Bilateral visual loss in the Tolosa-Hunt syndrome

Monteiro, Mário Luiz Ribeiro

doi:10.5935/0004-2749.19930026

SUMMARY

This paper describes a 65-year-old man with Tolosa-Hunt syndrome who presented with unilateral painful ophthalmoplegia and bilateral visual loss. Cranial CT scan revealed an enhancing mass at the right superior orbital fissure and optic canal but a biopsy showed only chronic inespecific inflammation. Treatment with corticosteroid resulted in marked improvement although One eye remained blind. The inflammatory process involved the right superior orbital fissure and optic nerve and presumably extended across the skull base to involve the contralateral optic nerve.

Key words:
Tolosa-Hunt syndrome - Painful Ophthalmoplegia

RESUMO

Este trabalho relata um paciente de 65 anos, sexo masculino, com síndrome de Tolosa-Hunt que apresentou oftalmoplegia dolorosa unilateral e perda visual bilateral. A tomografia computadorizada mostrou uma lesão hipercaptante na fissura orbitária superior e no canal óptico que à biópsia revelou se tratar de processo inflamatório crônico inespecífico. Tratamento com corticosteróides resultou em melhora acentuada do quadro embora um olho tenha permanecido sem percepção luminosa. O processo inflamatório envolvia afissura orbitária superior e o nervo óptico à direita e presumivelmente se extendia através da base do crânio para envolver o nervo óptico contralateral.

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REFERENCES

¹
KLINE, L. B.- The Tolosa-Hunt syndrome. Surv. Ophthalmol. 27: 79-95, 1982.
²
HOLT, H.; de ROTTH, A.- Orbital apex and sphenoid fissure syndrome. Arch. Ophthalmol. 24: 731-41,1940.
³
OTHER, A.- Painful ophthalmoplegia. Acta Ophthalmol. 45: 371-3, 1967.
⁴
MATHEW, N. T.; CHANDY, J.- Painful ophthalmoplegia. J. Neurol. Sci. 11: 243-56, 1970.
⁵
SCHATZ, N. J.; FARMER, P.- Tolosa-Hunt syndrome: The pathology of painful ophthalmoplegia. In: SMITH, J. L. (ed): Neuro-ophthalmology. Symposium of the University of Miami and the Bascom Palmer Eye Institute. Vol. VI., St. Louis, CV Mosby, 1976, pp 102-12.
⁶
SAFRULL, K. M.; DHIR, S. P., JAIN, I. S.- Tolosa-Hunt syndrome. Ind. J. Ophthalmol. 25: 21-6, 1977.
⁷
ANDERSON, B. I.- Unusual course of painful ophthalmoplegia. Report of a case. Acta Ophthalmol. 58: 841-8, 1980.
⁸
TOLOSA, E.- Periarteritic lesions of the carotid siphon with the clinical features of a carotid infraclinoid aneurysm. J. Neurol. Neurosurg. Psychiatry 17: 300-2, 1954.
⁹
SOLBRIG, M. V.; KELLY, W. M.; KRETZSCHMAR, F.; DAVIS, R. L. - Tolosa-Hunt syndrome - a case report and postmortem study. To be published.
¹⁰
KWAN, E. S. K.; WOLPERT, S. M.; HEDGES III, T. R.; LAUCELLA, M.- Tolosa-Hunt syndrome revisited: not necessarily a diagnosis of exclusion. A.J.R. 150: 413-8,1988.
¹¹
THOMAS, D. J. B.; CHARLESWORTH, M. C.; AFSHAR, F.; GALTON, D. J.- Computerized axial tomography and magnetic resonance scanning in the Tolosa-Hunt syndrome. Br. J. Ophthalmol. 72: 299-300, 1988.

Publication Dates

Publication in this collection
Oct 1993

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
KLINE, L. B.- The Tolosa-Hunt syndrome. Surv. Ophthalmol. 27: 79-95, 1982.

[2] ²
HOLT, H.; de ROTTH, A.- Orbital apex and sphenoid fissure syndrome. Arch. Ophthalmol. 24: 731-41,1940.

[3] ³
OTHER, A.- Painful ophthalmoplegia. Acta Ophthalmol. 45: 371-3, 1967.

[4] ⁴
MATHEW, N. T.; CHANDY, J.- Painful ophthalmoplegia. J. Neurol. Sci. 11: 243-56, 1970.

[5] ⁵
SCHATZ, N. J.; FARMER, P.- Tolosa-Hunt syndrome: The pathology of painful ophthalmoplegia. In: SMITH, J. L. (ed): Neuro-ophthalmology. Symposium of the University of Miami and the Bascom Palmer Eye Institute. Vol. VI., St. Louis, CV Mosby, 1976, pp 102-12.

[6] ⁶
SAFRULL, K. M.; DHIR, S. P., JAIN, I. S.- Tolosa-Hunt syndrome. Ind. J. Ophthalmol. 25: 21-6, 1977.

[7] ⁷
ANDERSON, B. I.- Unusual course of painful ophthalmoplegia. Report of a case. Acta Ophthalmol. 58: 841-8, 1980.

[8] ⁸
TOLOSA, E.- Periarteritic lesions of the carotid siphon with the clinical features of a carotid infraclinoid aneurysm. J. Neurol. Neurosurg. Psychiatry 17: 300-2, 1954.

[9] ⁹
SOLBRIG, M. V.; KELLY, W. M.; KRETZSCHMAR, F.; DAVIS, R. L. - Tolosa-Hunt syndrome - a case report and postmortem study. To be published.

[10] ¹⁰
KWAN, E. S. K.; WOLPERT, S. M.; HEDGES III, T. R.; LAUCELLA, M.- Tolosa-Hunt syndrome revisited: not necessarily a diagnosis of exclusion. A.J.R. 150: 413-8,1988.

[11] ¹¹
THOMAS, D. J. B.; CHARLESWORTH, M. C.; AFSHAR, F.; GALTON, D. J.- Computerized axial tomography and magnetic resonance scanning in the Tolosa-Hunt syndrome. Br. J. Ophthalmol. 72: 299-300, 1988.

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