Tolosa-Hunt Syndrome Preceded by Facial Palsy

Authors

  • Enrico Tessitore MD,

    1. From the Operative Unit of Neurotraumatology, Department of Neurosurgery, Second University of Naples, Italy.
    2. Stroke Unit, Division of Neurology, CTO Hospital of Naples, Italy.
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  • Alessandro Tessitore MD

    1. From the Operative Unit of Neurotraumatology, Department of Neurosurgery, Second University of Naples, Italy.
    2. Stroke Unit, Division of Neurology, CTO Hospital of Naples, Italy.
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Address all correspondence to Dr. Enrico Tessitore, Via Astalonga 180, San Giuseppe Vesuviano, 80047 Naples, Italy.

Abstract

The Tolosa-Hunt syndrome consists of a painful ophthalmoplegia related to a granulomatous inflammatory process in the cavernous sinus, which may be documented by cerebral magnetic resonance imaging with gadolinium enhancement.

Two cases of Tolosa-Hunt syndrome preceded by facial palsy observed in 1998 at the Department of Neurosurgery of the Second University of Naples are presented here. Both patients developed Tolosa-Hunt syndrome following an ipsilateral facial palsy that resolved in about 15 days with medical treatment. Cerebral magnetic resonance imaging with gadolinium enhancement showed, in both cases, inflammatory tissue in the cavernous sinus. The patients underwent corticosteroid therapy (prednisolone, 80 mg per day, intravenously) with pain regression. In the first case, the patient experienced recurrence of the syndrome that was definitively resolved with further corticosteroid treatment.

The rare reports of facial palsy in patients with Tolosa-Hunt syndrome suggest the inclusion of this disease in the so-called multiple cranial nerve palsy syndrome. It is probable that Tolosa-Hunt syndrome has an inflammatory pathogenesis.

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