Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of atypical Tolosa-Hunt syndrome with a contrast enhanced lesion of the oculomotor and trigeminal nerves on MRI

Daisuke Yamamoto, M.D.1), Emiko Tsuda, M.D.1), Masaki Saitoh, M.D.1), Tomihiro Imai, M.D.2) and Shun Shimohama, M.D.1)

1)Department of Neurology, Sapporo Medical University School of Medicine
2)Department of Occupational Therapy, Sapporo Medical University School of Health Sciences

A 30-year-old woman was admitted to our hospital because of intractable orbital pain and ptosis on the left side. On admission, she had left oculomotor, ophthalmic and maxillary nerves palsy. MRI revealed a contrast enhanced lesion of the left oculomotor and trigeminal nerves through the covernous sinus and orbita. We diagnosed her condition as Tolosa-Hunt syndrome. The orbital pain was resolved within 48-hours by the pulse therapy with intra-venous methylpredonisolone. The cranial nerve palsy was gradually improved, but never reached complete remission. The left oculomotor and trigeminal nerves also remained enhanced on MRI until 200 days from the onset. Although there have been few reports to demonstrate the contrast enhancement of cranial nerves in Tolosa-Hunt syndrome, these MRI findings may be a specific indicator of the pathological process.
Full Text of this Article in Japanese PDF (2686K)

(CLINICA NEUROL, 54: 903|906, 2014)
key words: Tolosa-Hunt syndrome, MRI, oculomotor nerve, trigeminal nerve, enhancement

(Received: 26-Dec-13)