A Case of Tolosa-Hunt Syndrome

ABSTRACT

Tolosa-Hunt syndrome (cavernoussinusitis) is a term used to describe diseases involving the content of the superior orbital fissure and/or anterior cavernous sinus, presenting as painful ophthalmoplegia, along with granulomatous inflammation. The third, fourth, fifth and sixth cranial nerves pass through the carvenous sinus. Thus, when infection spreads into the cavernous sinus, these cranial nerves may be paralyzed and corneal reflexes may disappear. Pain and hypoesthesia of the area, which is innervated by the maxillary branch of the fifth nerve, can be accompanied with this syndrome. Tolosa-Hunt syndrome can be improved dramatically with high-dose steroid therapy. A 15-year-old boy who had retro-orbital pain, diplopia and exophthalmos was diagnosed with sphenoid sinusitis by PNS CT. He underwent brain MRI and neurologic examination because the symptoms persisted after the endoscopic sinus surgery. He was finally diagnosed with Tolosa-Hunt syndrome and his symptoms were improved with steroid therapy.