Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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June 16, 2008
Tolosa-Hunt Syndrome Caused by Tuberculosis
- Inflammatory involvement of cavernous sinus(es) can produce painful or painless opthalmoplegia (Tolosa-Hunt syndrome).
- Other symptoms include headaches, facial nerve palsies, ptosis, double vision, fever, chronic fatigue, vertigo, arthralgias & exophthalmos.
- Differential diagnosis: tuberculosis, pseudotumor, inflammatory myofibroblastic tumor, meningioma, lymphoma, sarcoidosis, Wegener disease, intraorbital tumors, perineural spread of head & neck malignancies, & fungal infections (in many patients, Tolosa-Hunt remains idiopathic despite extensive investigations)
- Thick leptomeningeal enhancement elsewhere should raise suspicion for a granulomatous disease such as tuberculosis.