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Tolosa–Hunt syndrome misdiagnosed as sinusitis complication

Published online by Cambridge University Press:  16 January 2008

V A Lachanas ,
G T Karatzias ,
I Tsitiridis ,
I Panaras  and
V G Sandris
V A Lachanas
Affiliation:
Department of Otolaryngology, General Hospital of Larissa, Larissa, Greece
G T Karatzias*
Affiliation:
Department of Otolaryngology, General Hospital of Larissa, Larissa, Greece
I Tsitiridis
Affiliation:
Department of Otolaryngology, General Hospital of Larissa, Larissa, Greece
I Panaras
Affiliation:
Department of Otolaryngology, General Hospital of Larissa, Larissa, Greece
V G Sandris
Affiliation:
Department of Otolaryngology, General Hospital of Larissa, Larissa, Greece
*
Address for correspondence: Dr George T Karatzias, Consultant, 4 Skra Str, 41221 Larissa, Greece. Fax: +30 2410615466 E-mail: vlachanas@yahoo.com
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Abstract

Objective:

Tolosa–Hunt syndrome is a rare condition of painful ophthalmoplegia combined with ipsilateral ocular motor nerve palsies, caused by non-specific granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. A case of Tolosa–Hunt syndrome misdiagnosed as sinusitis orbital complication is reported.

Case report:

A patient suffering from left periorbital pain, upper eyelid oedema and ptosis, and horizontal diplopia, diagnosed as sinusitis orbital complication, was referred to our department. Clinical evaluation revealed only a left VIth nerve paresis. Haematological studies, cerebrospinal fluid tests and computed tomography scanning were negative. A magnetic resonance imaging (MRI) scan showed enhancement of the left cavernous sinus. Corticosteroid therapy was commenced, and within three days all symptoms disappeared. A diagnosis of Tolosa–Hunt syndrome was made. Follow-up MRI studies were normal.

Conclusion:

Tolosa–Hunt syndrome, although rare, is a nosological entity that otolaryngologists must bear in mind. Magnetic resonance imaging studies are essential in the diagnosis and follow up of these patients, in order to avoid a mistaken Tolosa–Hunt syndrome diagnosis.

Keywords

Tolosa-Hunt SyndromeSinusitis
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 1 , January 2008 , pp. 97 - 99
Copyright
Copyright © JLO (1984) Limited 2006

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