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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.55 no.1 São Paulo  1997

https://doi.org/10.1590/S0004-282X1997000100016 

Síndrome de Tolosa-Hunt: dificuldades no diagnóstico e padrão de resposta à prednisona

 

Tolosa-Hunt syndrome: troubles in diagnosing and pattern of response to prednisone

 

 

Paulo Eduardo Mestrinelli CarrilhoI; Fábio Iuji YamamotoII; Milberto ScaffIII

IMédico pós-graduando. Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP)
IIMestre em Neurologia, Médico Supervisor da Clínica Neurológica do Hospital das Clínicas da FMUSP
IIIProfessor Titular. Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

 

 


RESUMO

A síndrome de Tolosa-Hunt (STH) consiste de oftalmoplegia dolorosa relacionada a processo inílamatório granulomatoso no seio cavernoso. Seu diagnóstico só pode ser firmado quando outras causas potenciais de oftalmoplegia dolorosa forem descartadas. Resposta satisfatória e padronizada a corticosteróides, associada a evolução benigna, pode reforçar essa possibilidade, embora pseudotumor orbitário e neoplasias do tipo linfoma e até meningioma possam suscitar dúvidas no diagnóstico diferencial, pois também podem apresentar boa resposta a essa medicação. Faz-se necessário, portanto, ampla investigação complementar. Apresentamos estudo clínico-radiológico-laboratorial de cinco pacientes com STH. Prednisona foi utilizada em doses entre 40 e 80 mg/dia. Houve resposta analgésica excelente, com remissão da dor em menos de 48 horas em 4 pacientes. Houve melhora mais lenta da oftalmoplegia, que regrediu completamenteentre 4 e 45 dias em todos os pacientes.

Palavras-chave: síndrome de Tolosa Hunt, oftalmoplegia, doenças orbitárias, prednisona.


ABSTRACT

The Tolosa-Hunt syndrome (THS) consists of a painful ophthalmoplegia related to granulomatous inflammatory process in the cavernous sinus. According to recent concepts, the diagnosis is established only when other causes of painful ophthalmoplegia are ruled out. A typical pattern of response to corticosteroids associated with a benign evolution may reinforce this possibility. Tumors such as lymphoma and meningioma and orbital pseudotumors can make difficult the differential diagnosis because they also may respond to steroids. Thus it is always necessary to make an extensive ancillary investigation. We performed a clinical, laboratory and radiologic study of five patients with THS. Prednisone was used in all, with dosages ranging from 40 to 80 mg/day. In four patients there was a dramatic analgesic effect in less than 48 hours. Improvement of the ophthalmoplegia was not so fast but occurred in all with a complete remission in 4 to 45 days.

Key words: Tolosa-Hunt syndrome, ophthalmoplegia, orbital diseases, prednisone.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

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Aceite: 31-outubro-1996.

 

 

Dr. Paulo Eduardo Mestrinelli Carrilho - Divisão de Clínica Neurológica, Hospital das Clínicas FMUSP - Avenida Dr. Eneas de Carvalho Aguiar 255, Instituto Central, Sala 5011 - 05403-000 São Paulo SP - Brasil.

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