Jumraini Tammasse is the Doctor of medical faculty graduates
UNHAS in 1996 and took the education of neurologist in 2005 he also became a
lecturer at several faculties of medicine in Indonesia. Some of the works that
have been written one of them are the journal IKM Unhas, 2012-08-22; the effect
of music therapy on the motor scale increase in patients with acute ischemic
Tolosa-Hunt syndrome (THS) is caused by idiopathic inflammation process
in the cavernous sinus, superior orbital fissure or orbit. THS is a rare
disease; the yearly incidence is 1:1.000.000. The main clinical symptoms is
painful ophthalmoplegia, accompanied by ipsilateral headache, paresis of one or
more of the ipsilateral IIIrd, IVth and/or VIth cranial nerves, MRI abnormality
or biopsy, and cannot be categorized as any other disease. THS resolves
adequately with corticosteroids within 24-72 hours after therapy.
Case report: Male, 53 y.o., was admitted because of a right
painful ophthalmoplegia, constant, 2 weeks onsets, ipsilateral headache,
accompanied by diplopia and ptosis of the right eyelid. The pain was not
relieved by analgesics. No history of fever, trauma, or a similar disease.
Neurological examination featured exotropia, paresis of right IIIrd and IVth
cranial nerves. Laboratory findings, CT angiography, and Brain MRI were normal.
There was clinical improvement within 24 hours after initiation of
methylprednisolone which was continued by tapering-off oral prednisone.
Conclusion: THS is an exclusion diagnosis and must be differentiated from other causes of painful ophthalmoplegia. Careful follow-up is required to diagnose THS. The diagnosis should not depend on MRI only but adapted to the clinical finding and therapeutic response also.
Figure 1. Ophthalmology examination showed right palpebral ptosis, exotropia at the primary position of the right eye and dilatation of the right eye pupil.