Ptosis Revealing A Tolosa Hunt Syndrome: A Case Report

Abstract

Tolosa-Hunt Syndrome is a rare condition with an undetermined etiology that manifests clinically as unilateral orbital pain and ophthalmoplegia. We report the case of a 48-year-old female who developed acute eight upper lid ptosis within 2 days, which was preceded by retro-orbital pain without other neurological deficits. Unilateral 3d, 4th and 6th cranial nerves palsy were observed. An emergent brain magnetic resonance image (MRI)  revealed a cavernous sinus asymmetry, with an oblong, well-defined thickening of the right cavernous sinus. The MRI revealed no signs of cavernous thrombosis nor intracranial lesion. THS was diagnosed, and corticosteroid treatment was initiated, with complete improvement in symptoms.  A non-specific inflammation of the cavernous sinus causes the Tolosa-Hunt syndrome. Diplopia and ptosis can occur as a result of nerve paralysis. THS management is challenging and should be multidisciplinary, involving ophthalmologists, neurologists, and neuroradiologists. It is characterized by rapid response to treatment with steroids.