Tolosa-Hunt Syndrome Follow-up

Updated: Dec 06, 2017
  • Author: Danette C Taylor, DO, MS, FACN; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Follow-up

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

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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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Prognosis

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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. [10]
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Patient Education

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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.
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