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Date Published: 09/07/2024
Online Published: 31/03/2023
Abstract Views: 445
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DOI: https://doi.org/10.55046/vjrnm.54.995.2024
Issue
No. 54 (2024)
Section
Medical Forum
How to Cite
Nguyen , T. L., Nguyen, T. B., Le, V. D., & Le, T. L. (2023). Diagnostic imaging of Tolosa-Hunt Syndrome: Two rare cases report diagnosed at Hanoi Medical University Hospital. Vietnamese Journal of Radiology and Nuclear Medicine, 54, 84-89. https://doi.org/10.55046/vjrnm.54.995.2024

Diagnostic imaging of Tolosa-Hunt Syndrome: Two rare cases report diagnosed at Hanoi Medical University Hospital

Nguyen Thu Lan1,, Nguyen Thai Binh2, Le Viet Dung1, Le Tuan Linh2
1 Center for CDHA and CTQQ Hanoi Medical University Hospital
2 Department of College of Medicine, Hanoi Medical University

Main Article Content

Abstract

Tolosa-Hunt syndrome is a rare inflammatory process of unknown etiology, affecting the cavernous sinus or/within the superior orbital fissure, with an incidence of 1-2 per million people. Because of the difficulty in establishing histological evidence, his diagnosis is based on a set of criteria established by the International Headache Society. MRI allows indirect visualization of the granuloma and plays a key role in diagnosis and follow-up. We would like to report two cases with the diagnosis of Tolosa- Hunt syndrome at Hanoi Medical University Hospital.


Two patients, a 52-year-old male and a 50-year-old female, came to the hospital because of orbital pain and ophthalmoplegia for 3 months. Blood tests, cerebrospinal fluid, thyroid hormone levels, and screening for infection as well as screening for primary tumors were performed, which showed no abnormality. 1.5T brain MRI in both patients revealed enlarged, non-massive lesions in the ipsilateral cavernous sinus with clinical symptoms, suggesting an inflammatory cause. Tolosa Hunt syndrome is presented after other causes have been ruled out. Both patients responded well to high-dose corticosteroid therapy and did not relapse after 6-8 months of follow-up. Therefore, we have a final diagnosis of Tolosa-Hunt syndrome.

Article Details

Keywords

Tolosa-Hunt syndrome, cavernous sinus, superior orbital fissure, ophthalmoplegia, orbital pain

References

1. Iaconetta G, Stella L, Esposito M, Cappabianca P. Tolosa-Hunt syndrome extending in the cerebello-pontine angle. Cephalalgia. 2005;25(9):746-750. doi:10.1111/j.1468-2982.2005.00924.x 2. Aidara CM, Kouna P, Mapaga JN, et al. High-Field MRI Contribution in Tolosa-Hunt Syndrome (THS). Report of Two Cases and Review of Literature. Open Journal of Radiology. 2018;8(3):141-149. doi:10.4236/ojrad.2018.83016
3. Kastirr I, Kamusella P, Andresen R. Bilateral Painful Ophthalmoplegia: A Case of Assumed Tolosa-Hunt Syndrome. J Clin Diagn Res. 2016;10(3):TD16-17. doi:10.7860/JCDR/2016/16703.7496
4. Sugie K, Morikawa M, Taoka T, Hirano M, Ueno S. Serial neuroimaging in tolosa-hunt syndrome with acute bilateral complete ophthalmoplegia. J Neuroimaging. 2011;21(1):79-82. doi:10.1111/j.1552-6569.2009.00381.x
5. Tolosa E. Periarteritic lesions of the carotid siphon with the clinical features of a carotid infraclinoidal aneurysm. J Neurol Neurosurg Psychiatry. 1954;17(4):300-302. doi:10.1136/jnnp.17.4.300
6. Kline LB, Hoyt WF. The Tolosa-Hunt syndrome. J Neurol Neurosurg Psychiatry. 2001;71(5):577-582. doi:10.1136/ jnnp.71.5.577
7. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9-160. doi:10.1111/j.1468-2982.2003.00824.x
8. Jain R, Sawhney S, Koul RL, Chand P. Tolosa-Hunt syndrome: MRI appearances. J Med Imaging Radiat Oncol. 2008;52(5):447-451. doi:10.1111/j.1440-1673.2008.01988.x
9. AKPINAR ÇK, ÖZBENLİ T, DOĞRU H, İNCESU L. Tolosa-Hunt Syndrome - Cranial Neuroimaging Findings. Noro Psikiyatr Ars. 2017;54(3):251-254. doi:10.5152/npa.2016.13791
10. Wani NA, Jehangir M, Lone PA. Tolosa–Hunt Syndrome Demonstrated by Constructive Interference Steady State Magnetic Resonance Imaging. J Ophthalmic Vis Res. 2017;12(1):106-109. doi:10.4103/2008-322X.200171
11. Shama S, Ghieda U. Superior orbital fissure syndrome and its mimics: What the radiologist should know? The Egyptian Journal of Radiology and Nuclear Medicine. 2012;43:589-594. doi:10.1016/j.ejrnm.2012.09.009
12. La Mantia L, Curone M, Rapoport AM, Bussone G, International Headache Society. Tolosa-Hunt syndrome: critical literature review based on IHS 2004 criteria. Cephalalgia. 2006;26(7):772-781. doi:10.1111/j.14682982.2006.01115.x
13. Cakirer S. MRI findings in Tolosa-Hunt syndrome before and after systemic corticosteroid therapy. European journal of radiology. 2003;45:83-90. doi:10.1016/S0720-048X(02)00012-8
14. Schuknecht B, Sturm V, Huisman T a. GM, Landau K. Tolosa-Hunt syndrome: MR imaging features in 15 patients with 20 episodes of painful ophthalmoplegia. Eur J Radiol. 2009;69(3):445-453. doi:10.1016/j.ejrad.2007.11.034
15. Msigwa SS, Li Y, Cheng X. Tolosa Hunt Syndrome: Current Diagnostic Challenges and Treatment. Yangtze Medicine. 2020;4(2):140-156. doi:10.4236/ym.2020.42014