ABSTRACT
We herein present the case of a 38-year-old woman with left-sided oculomotor paralysis with ocular pain that developed after a respiratory infection. Her serum was positive for IgM against GM2 and GalNAc-GD1a gangliosides and cytomegalovirus. Thin-slice magnetic resonance imaging revealed enhanced abnormal tissue located primarily in the superolateral part of the left-sided cavernous sinus, which corticosteroids subsequently obscured with immediate resolution of the patient's ocular symptoms. These clinical features were consistent with those of Tolosa-Hunt syndrome (THS). Our findings in the present patient suggest that cytomegalovirus may provoke granuloma formation in the cavernous sinus, as reported in other various organs, thereby leading to the development of THS.
Subject(s)
Cytomegalovirus Infections/complications , Cytomegalovirus/pathogenicity , Respiratory Tract Infections/complications , Tolosa-Hunt Syndrome/etiology , Adult , Antibodies, Viral/blood , Autoantibodies/blood , Autoantibodies/immunology , Cavernous Sinus/virology , Cytomegalovirus/immunology , Cytomegalovirus Infections/immunology , Diplopia/etiology , Female , G(M1) Ganglioside/analogs & derivatives , G(M1) Ganglioside/immunology , G(M2) Ganglioside/immunology , Granuloma/etiology , Granuloma/virology , Humans , Imaging, Three-Dimensional , Immunocompetence , Immunoglobulin M/blood , Macrophages/immunology , Macrophages/pathology , Magnetic Resonance Imaging , Prednisolone/therapeutic use , Respiratory Tract Infections/immunology , Respiratory Tract Infections/virology , Tolosa-Hunt Syndrome/drug therapy , Tolosa-Hunt Syndrome/immunology , Tolosa-Hunt Syndrome/pathology , Tolosa-Hunt Syndrome/virologyABSTRACT
Viral infection is a rare cause of painful ophthalmoplegia. We report on a 67-year-old patient who developed painful double vision after a vesicular skin rash on the left forehead. MRI disclosed simultaneous inflammatory lesions in all extraocular muscles, the second and third cranial nerve, as well as pathological signal intensity along the spinal trigeminal tract and nucleus within the medulla oblongata and the pons. Cerebrospinal fluid and serum tests for varicella zoster were positive. The patient was treated effectively with intravenous acyclovir and methylprednisolone. Simultaneous lesions in various neighbouring neural structures may be characteristic for the highly neurotropic behaviour of the herpesviridae and should be considered as a cause of painful ophthalmoplegia that can be depicted by appropriate imaging.
