Tolosa-Hunt Syndrome Follow-up
- Author: Danette C Taylor, MS, DO, FACN; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS more...
Further Outpatient Care
Supervise a tapering schedule for the steroids and monitor for steroid-related adverse effects. Because the diagnosis of Tolosa-Hunt syndrome is often made clinically without histopathologic confirmation, vigilance must be maintained for the possibility of alternative masquerading diagnosis.
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- Complications of high-dose and/or prolonged steroid use are common.
- In patients with extracavernous sinus involvement affecting the optic nerve, loss of vision may occur.
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- Typically, the prognosis is considered good. Patients usually respond to corticosteroids, and spontaneous remission can occur, although permanent ocular motor deficits may remain.
- Relapse can occur in as many as 40% of patients successfully treated for Tolosa-Hunt syndrome. This typically occurs on the same side as the original lesion but can be observed on the opposite side. Spontaneous remission can occur; patients who have experienced spontaneous remission appear to have as much risk of reoccurrence as those treated with medication. Gimenez-Roldan et al have reported that relapses may occur as long as 13 years after initial diagnosis and treatment.
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- Patients should understand that this is an idiopathic condition that is usually self-limited. Relapses may occur (30-40% of patients may experience relapse), and patients should know that the course of any relapse often follows the original event but may require additional testing. Patients should have an idea of the differential diagnosis of Tolosa-Hunt syndrome and report any new symptoms or side effects from treatment to the physician.
- The risks associated with the use of high-dose steroids should be emphasized prior to the onset of treatment.
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 Jul. 26 (7):772-81. [Medline].
Zanus C, Furlan C, Costa P, Cosentini D, Carrozzi M. The Tolosa-Hunt syndrome in children: a case report. Cephalalgia. 2009. 29:1232-1237.
Lachanas VA, Karatzias GT, Tsitiridis I, Panaras I, Sandris VG. Tolosa-Hunt syndrome misdiagnosed as sinusitis complication. J Laryngol Otol. 2008 Jan. 122(1):97-9. [Medline].
Colnaghi S, Versino M, Marchioni E, Pichiecchio A, Bastianello S, Cosi V, et al. ICHD-II diagnostic criteria for Tolosa-Hunt syndrome in idiopathic inflammatory syndromes of the orbit and/or the cavernous sinus. Cephalalgia. 2008 Jun. 28(6):577-84. [Medline].
Goto Y, Hosokawa S, Goto I, et al. Abnormality in the cavernous sinus in three patients with Tolosa-Hunt syndrome: MRI and CT findings. J Neurol Neurosurg Psychiatry. 1990 Mar. 53(3):231-4. [Medline].
Yagi A, Sato N, Taketomi A, et al. Normal cranial nerves in the cavernous sinuses: contrast-enhanced three-dimensional constructive interference in the steady state MR imaging. AJNR Am J Neuroradiol. 2005 Apr. 26(4):946-50. [Medline].
Foubert-Samier A, Sibon I, Maire JP, Tison F. Long-term cure of Tolosa-Hunt syndrome after low-dose focal radiotherapy. Headache. 2005 Apr. 45 (4):389-91. [Medline].
Cohn DF, Carasso R, Streifler M. Painful ophthalmoplegia: the Tolosa-Hunt syndrome. Eur Neurol. 1979. 18(6):373-81. [Medline].
Gimenez-Roldan S, Guillem A, Munoz L. [Long-term risk of relapses in Tolosa-Hunt syndrome]. Neurologia. 2006 Sep. 21(7):382-5. [Medline].
Barontini F, Maurri S, Marrapodi E. Tolosa-Hunt syndrome versus recurrent cranial neuropathy. Report of two cases with a prolonged follow-up. J Neurol. 1987 Feb. 234(2):112-5. [Medline].
Bruyn GW, Ferrari M, de Beer FC. Migraine, Tolosa-Hunt syndrome and pleocytosis. Correlation or coincidence?. Clin Neurol Neurosurg. 1984. 86(1):33-41. [Medline].
Hunt WE. Tolosa-Hunt syndrome: one cause of painful ophthalmoplegia. J Neurosurg. 1976 May. 44(5):544-9. [Medline].
Johnston JL. Parasellar syndromes. Curr Neurol Neurosci Rep. 2002 Sep. 2(5):423-31. [Medline].
Kline LB. The Tolosa-Hunt syndrome. Surv Ophthalmol. 1982 Sep-Oct. 27(2):79-95. [Medline].
Kline LB, Hoyt WF. The Tolosa-Hunt syndrome. J Neurol Neurosurg Psychiatry. 2001 Nov. 71(5):577-82. [Medline].
Kobor J, Voros E, Deak A. Magnetic resonance imaging in Tolosa-Hunt syndrome. Eur J Pediatr. 2004 Dec. 163(12):753-4. [Medline].
Kwan ESK, Wolpert SM, Hedges TR III. Tolosa-Hunt revisited: Not necessarily a diagnosis of exclusion. Am J Radiol. 1989. 71:932.
La Mantia L, Erbetta A, Bussone G. Painful ophthalmoplegia: an unresolved clinical problem. Neurol Sci. 2005 May. 26 Suppl 2:s79-82. [Medline].
Lane R, Davies P. Ophthalmoplegic migraine: the case for reclassification. Cephalalgia. 2010 Jun. 30(6):655-61. [Medline].
Lo YL, Chan LL, Pan A, Ratnagopal P. Acute ophthalmoparesis in the anti-GQ1b antibody syndrome: electrophysiological evidence of neuromuscular transmission defect in the orbicularis oculi. J Neurol Neurosurg Psychiatry. 2004 Mar. 75(3):436-40. [Medline].
Rehman HU. A woman with headache and ptosis. QJM. 2012 Jan 20. [Medline].
Roca PD. Painful ophthalmoplegia: the Tolosa-Hunt syndrome. Ann Ophthalmol. 1975 Jun. 7(6):828-34. [Medline].
Schutta HS. Diseases of the dura mater. Joynt R, Griggs R, eds. Clinical Neurology. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1993. 34-44.
Smith JL, Taxdal DS. Painful ophthalmoplegia. The Tolosa-Hunt syndrome. Am J Ophthalmol. 1966 Jun. 61(6):1466-72. [Medline].
Sondheimer FK, Knapp J. Angiographic findings in the Tolosa-Hunt syndrome: painful ophthalmoplegia. Radiology. 1973 Jan. 106(1):105-12. [Medline].
Spector RH, Fiandaca MS. The "sinister" Tolosa-Hunt syndrome. Neurology. 1986 Feb. 36(2):198-203. [Medline].
Troost BT. Miller NR, Newman NJ, eds. Walsh & Hoyt's Clinical Neuro-Ophthalmology. Philadelphia, Pa: Williams & Wilkins Company; 1998. 1727-29.
Vallat JM, Vallat M, Julien J, et al. Painful ophthalmoplegia (Tolosa-Hunt) accompanied by peripheral facial paralysis. Ann Neurol. 1980 Dec. 8(6):645. [Medline].
Yousem DM, Atlas SW, Grossman RI, et al. MR imaging of Tolosa-Hunt syndrome. AJR Am J Roentgenol. 1990 Jan. 154(1):167-70. [Medline].