[Tolosa-Hunt syndrome and orbital pseudotumour. Overlapping conditions in a case with an unusual clinical profile]. / Síndrome de Tolosa-Hunt y pseudotumor orbitario. Entidades solapadas en un caso con perfil clínico no habitual.

INTRODUCTION: The origin of Tolosa-Hunt syndrome (THS) and orbital pseudotumour (OP) is not fully understood. It is acknowledged as having an unspecific granulomatous inflammatory nature in different locations. Although there are differences between the clinical features of the two conditions, they also share a number of physiopathogenetic, therapeutic and, in some cases, iconographic similarities. Possible clinical recurrences are common in the two conditions and a broad differential diagnosis is required in all cases. Yet, the association of both processes in the same patient, with radiological proof of the migration of the inflammatory injury, is not frequent. CASE REPORT: We report the case of a male patient with a long history of recurring unilateral painful ophthalmoplegia that was sensitive to steroids; criteria for THS were fulfilled and there was later development of homolateral OP, six years after the onset of his symptoms. The findings in serial studies conducted with magnetic resonance imaging must be highlighted. The patient was submitted to a surgical intervention to treat the orbital injury and a chronic inflammatory process was observed in the fibrotic phase. CONCLUSIONS: Inflammatory pseudotumour and THS perhaps have more points in common than has traditionally been accepted. To our knowledge few cases of the above-mentioned association have been reported in the same patient. When confronted by cases of painful ophthalmoplegia with excessive recurrences the physician must consider the possibility of other alternative diagnoses.

Síndrome de Tolosa-Hunt y pseudotumor orbitario. Entidades solapadas en un caso con perfil clínico no habitual / Tolosa-hunt syndrome and orbital pseudotumour. Overlapping conditions in a case with an unusual clinical profile

Introducción. El origen del síndrome de Tolosa-Hunt (STH) y del pseudotumor orbitario (PO) no es del todo conocido. Se admite su naturaleza inflamatoria granulomatosa localizaciones diferentes. Aunque existen divergencias clínicas entre ambos, también comparten similitudes fisiopatogénicas, terapéuticas y, en algunos casos, iconográficas. Las posibles recurrencias clínicas en ambas entidades son comunes y requieren en todo caso un amplio diagnóstico diferencial. Sin embargo, no es frecuente la asociación de ambos procesos en el mismo paciente, con documentación radiológica de la migración de la lesión inflamatoria. Caso clínico. Se presenta un paciente con oftalmoplejía dolorosa unilateral recurrente de larga evolución, sensible a esteroides, con criterios de STH y posterior desarrollo de PO homolateral, seis años tras el comienzo de sus síntomas. Destacamos los hallazgos de neuroimagen en resonancias magnéticas seriadas. Se interviene al paciente a causa de la lesión orbitaria, y se evidencia unproceso inflamatorio crónico en fase fibrótica. Conclusión. Quizás el pseudotumor inflamatorio y el STH compartan más aspectos comunes de lo tradicionalmente aceptado. En nuestro conocimiento existen pocos casos documentados de la citada asociación en elm ismo paciente. Los casos de oftalmoplejía dolorosa con excesivas recurrencias deben suscitar al clínico la posibilidad de otras alternativas diagnósticas (AU)

Introduction. The origin of Tolosa-Hunt syndrome (THS) and orbital pseudotumour (OP) is not fully understood. Itis acknowledged as having an unspecific granulomatous inflammatory nature in different locations. Although there are differences between the clinical features of the two conditions, they also share a number of physiopathogenetic, therapeutic and, in some cases, iconographic similarities. Possible clinical recurrences are common in the two conditions and a broad differential diagnosis is required in all cases. Yet, the association of both processes in the same patient, with radiological proof of the migration of the inflammatory injury, is not frequent. Case report. We report the case of a male patient with a long history of recurring unilateral painful ophthalmoplegia that was sensitive to steroids; criteria for THS were fulfilled and there was later development of homolateral OP, six years after the onset of his symptoms. The findings in serial studies conducted with magnetic resonance imaging must be highlighted. The patient was submitted to a surgical intervention to treat the orbital injury and a chronic inflammatory process was observed in the fibrotic phase. Conclusions. Inflammatory pseudotumour and THSperhaps have more points in common than has traditionally been accepted. To our knowledge few cases of the above-mentioned association have been reported in the same patient. When confronted by cases of painful ophthalmoplegia with excessive recurrences the physician must consider the possibility of other alternative diagnoses (AU)