Posters

Tolosa-Hunt syndrome complicated with cavernous sinus thrombosis

Poster Details

First Author: A.Alexa ROMANIA

Co Author(s):    A. Cantemir   M. Belibou   P. Ginju   C. Nechita   C. Bogdanici   D. Chiselita     

Abstract Details

Purpose:

The Tolosa-Hunt syndrome is a rare clinical entity characterized by painful opthalmoplegia caused by an idiopathic inflammation of the cavernous sinus, the differential diagnosis is complex due to a wide range of diseases with similar clinical presentation. Our purpose is to present the management of a challenging clinical case with a difficult pluridisciplinary approach.

Setting:

Ophtalmology Department, Saint Spiridon Emergency Hospital, Iasi, Romania

Methods:

A 85-year-old woman presented with left eye subacute painful proptosis, opthalmoplegia, hemoragic chemosis, decreased visual acuity, with no history of trauma and infection. The symptoms worsened gradually in the two weeks prior to presentation, although the patient underwent systemic and topic antibiotic treatment. The slit lamp examination revealed bilateral surgical aphakia, the fundus examination of the left eye show the presence of optic disc oedema and pallor, choroidal detatchment, the veins were dilated and sinuous. There were performed additional investigations: imaging (echography of the left eye, OCT, contrast cranial CT and angiography), blood tests and neurological examination.

Results:

Blood tests revealed a moderate inflammatory response. Contrast CT and angiography showed diffuse inflammation of the surrounding orbital tissue and extraocular muscles, occlusion of the superior ophtalmic vein and a filling defect of the left cavernous sinus-highly suggestive for thrombosis. Neurologic exam: left eye opthalmoplegia attributed to the local inflammation. Initial treatment in the neurology clinic: anticoalgulant, antibiotic and non steriodal anti inflammatory, with a favorable vascular outcome, but with the persistency of the local inflammatory process. The patient returned after 2 weeks, we initiated treatment with systemic intravenous corticosteroids, with a quick resolution of the local inflammation.

Conclusions:

Tolosa-Hunt is a complex syndrome of unknown etiology characterized by a granulomatous inflammation of the orbital tissues, with a difficult certainty diagnosis due to numerous pathologies that mimic its clinical presentation. Early recognition of the diagnosis and adapted treatment can lead to complete resolution of the symptoms and can avoid serious complications that may endanger the vital prognosis of the patient.

Financial Disclosure:

None