Dr.Saroj Gupta, G10559
Painful ophthalmoplegia consists of periorbital pain with ipsilateral ocular motor nerve palsies.The etiology include infections ,inflammations, tumors, vascular, trauma.A 25 yr old female presented with severe ptosis and third nerve paresis in LE since 8 days. Pupillary reaction and fundus was normal. RE was normal.MRI brain and orbit shows lobulated focal lesion with ill defined margin at anterior aspect left cavernous sinus and orbital apex.On postcontrast study,lesion shows intense homogenous enhancement.The cavernous part of left ICA was compressed and displaced medially.Based on the findings diagnosis of Tolosa-Hunt syndrome(THS)was made.Patient was given systemic steroid (Tab.Prednisolone1.0mg/kg)in tapering dose for 8 weeksThe response to systemic steroid was good. Ptosis and ocular movements completely improved within 1 week of therapy. THS is a steroid-responsive painful ophthalmoplegia secondary to idiopatic granulomatous inflammation of the cavernous sinus or orbital apex.
Leave a Comment