Jumraini Tammasse

Title: Clinical Outcome of Tolosa-Hunt Syndrome after Intravenous Steroid Therapy (Case Report)
Time: 10:45 - 11:15

Biography

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 stroke.

Research Interest


Abstract

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.