ABSTRACT
INTRODUCTION: Tolosa-Hunt syndrome is characterized by painful ophthalmoplegia due to idiopathic granulomatous inflammation of the cavernous sinus. Steroid therapy dramatically reverses the symptoms and clinical signs. Because they also may respond to steroids, tumors such as lymphoma and meningioma and orbital tumors can make differential diagnosis difficult. EXEGESIS: We report the case of a 78-year-old male patient in whom systemic lymphoma associated with inflammation of the cavernous sinus was uncovered by painful, gradually progressing, ophthalmoplegia mimicking Tolosa-Hunt syndrome. CONCLUSION: When faced with a clinical picture suggestive of the existence of Tolosa-Hunt syndrome clinical workup is mandatory and should lead to diagnosis of exclusion.
Subject(s)
Cavernous Sinus , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Tolosa-Hunt Syndrome/diagnosis , Aged , Anti-Inflammatory Agents/therapeutic use , Biopsy, Needle , Bone Marrow Examination , Diagnosis, Differential , Diplopia/etiology , Disease Progression , Giant Cell Arteritis/diagnosis , Humans , Inflammation , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Magnetic Resonance Imaging , Male , SteroidsABSTRACT
INTRODUCTION: Progressive multifocal leukoencephalopathy is a demyelinating disease resulting from an opportunistic infection of the central nervous system by JC papovavirus. It mostly occurs in patients with an underlying immunosuppressive disorder. In the era of acquired immunodeficiency syndrome it is observed with increasing frequency. EXEGESIS: We report the case of a non-HIV-infected patient who presented chronic lymphocytic leukemia with progressive multifocal leukoencephalopathy uncovered by both imaging and the presence of JC virus in the cerebrospinal fluid. CONCLUSION: Due to the lack of specific treatment, the disease is still rapidly progressive and fatal.
Subject(s)
JC Virus/isolation & purification , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukoencephalopathy, Progressive Multifocal/complications , Aged , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/cerebrospinal fluid , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Leukoencephalopathy, Progressive Multifocal/cerebrospinal fluid , Leukoencephalopathy, Progressive Multifocal/diagnosis , Magnetic Resonance Imaging , MaleABSTRACT
Herpes zoster is uncommonly followed by cerebral infarction. The pathophysiological mechanism remains uncertain. Outcome is favorable after early specific treatment. We report the case of a 70-year-old woman who developed right hemiparesis with aphasia 15 days after thoracic herpes zoster. The herpes zoster induced cerebral vasculitis was hypothesized as no other etiology could be identified after detailed assessment of the cerebral infarction including brain MRI and cerebrospinal fluid study, and as the clinical course responded to antiviral therapy.
