[Tolosa-Hunt syndrome following traumatic eye injury]. / Sindrome de Tolosa-Hunt tras un traumatismo ocular.

INTRODUCTION: Tolosa-Hunt syndrome (THS) is an idiopathic condition involving unilateral eye pain with involvement of oculomotor nerves which responds well to treatment with steroids. It is produced by idiopathic granulomatous inflammation of the cavernous sinus or the orbital apex. CASE REPORT: A 37-year-old male who was admitted to hospital due to a six-week history of blurred vision and pain in the left eye, which was later accompanied by full ipsilateral ophthalmoplegia. Some days prior to the onset of the clinical features, he suffered an accident which resulted in traumatic injury to the left eye. An examination showed data pointing to optic neuropathy in the left eye with complete extrinsic ocular motor palsy. Results of general analyses and lumbar puncture were normal. Magnetic resonance imaging (MRI) of the head revealed a thickening of the wall of the left cavernous sinus and of the ipsilateral orbital apex, which enhanced with gadolinium. Evoked potential studies showed axonal and demyelinating optic neuropathy on the left-hand side. Suspecting this to be a case of THS, treatment was established with high doses of corticoids, which brought about an improvement in the pain and eye movement but not in the blurred vision. A MRI control scan showed a clear improvement in comparison to the one carried out initially. CONCLUSIONS: In cases of painful ophthalmoplegia, the professional should suspect the existence of THS. If the apex of the orbit is affected through the superior orbital fissure, the optic nerve may be damaged. Traumatic injury can be one of the situations that trigger THS.

Síndrome de Tolosa-Hunt tras un traumatismo ocular / Tolosa-Hunt syndrome following traumatic eye injury

Introducción. El síndrome de Tolosa-Hunt (STH) es un cuadro idiopático de dolor orbital unilateral con afectación de nervios oculomotores con buena respuesta al tratamiento esteroideo. Se produce por la inflamación granulomatosa idiopática del seno cavernoso o del ápex orbitario. Caso clínico. Varón de 37 años que ingresó por un cuadro de seis semanas de evolución de visión borrosa y dolor ocular izquierdo al que posteriormente se le sumó una oftalmoplejía completa ipsilateral. Días antes de comenzar la clínica sufrió un traumatismo ocular accidental en el ojo izquierdo. La exploración mostró datos de neuropatía óptica izquierda junto con plejía completa de motores oculares extrínsecos. La analítica general y la punción lumbar fueron normales. La resonancia magnética (RM) craneal evidenció un engrosamiento de la pared del seno cavernoso izquierdo y del ápex orbitario ipsilateral, que realzaba con gadolinio. El estudio de potenciales evocados mostró una neuropatía óptica izquierda axonal y desmielinizante. Ante la sospecha de STH se inició tratamiento con alta dosis de corticoides, tras lo cual se produjo una mejoría del dolor y de la motilidad ocular, pero no de la visión borrosa. La RM de control reveló una evidente mejoría respecto a la inicial. Conclusiones. Ante una oftalmoplejía dolorosa debe sospecharse la existencia de un STH. Si se afecta el ápex de la órbita a través de la fisura orbitaria superior puede verse perjudicado el nervio óptico. Uno de los desencadenantes del STH puede ser un traumatismo (AU)

Introduction. Tolosa-Hunt syndrome (THS) is an idiopathic condition involving unilateral eye pain with involvement of oculomotor nerves which responds well to treatment with steroids. It is produced by idiopathic granulomatous inflammation of the cavernous sinus or the orbital apex. Case report. A 37-year-old male who was admitted to hospital due to a six-week history of blurred vision and pain in the left eye, which was later accompanied by full ipsilateral ophthalmoplegia. Some days prior to the onset of the clinical features, he suffered an accident which resulted in traumatic injury to the left eye. An examination showed data pointing to optic neuropathy in the left eye with complete extrinsic ocular motor palsy. Results of general analyses and lumbar puncture were normal. Magnetic resonance imaging (MRI) of the head revealed a thickening of the wall of the left cavernous sinus and of the ipsilateral orbital apex, which enhanced with gadolinium. Evoked potential studies showed axonal and demyelinating optic neuropathy on the left-hand side. Suspecting this to be a case of THS, treatment was established with high doses of corticoids, which brought about an improvement in the pain and eye movement but not in the blurred vision. A MRI control scan showed a clear improvement in comparison to the one carried out initially. Conclusions. In cases of painful ophthalmoplegia, the professional should suspect the existence of THS. If the apex of the orbit is affected through the superior orbital fissure, the optic nerve may be damaged. Traumatic injury can be one of the situations that trigger THS (AU)