Recurrent Tolosa-Hunt syndrome: a report of ten new cases

Ten patients (6F, 4M) with recurrent Tolosa-Hunt syndrome are reported. Bes ides ocular motor symptoms, one patient had trigeminal nerve involvement, o ne had ipsilateral ocular sympathicoplegia with miosis and ptosis, and one tinnitus during an episode of Tolosa-Hunt syndrome, ipsilateral to the pain side. One patient had Bell's palsy, one had a possible Raeder's syndrome, and one had a period of tinnitus between the Tolosa-Hunt syndrome episodes. Three of the 10 patients reported periods of periocular pain without ophth almoplegia between the Tolosa-Hunt episodes, the pain located ipsilateral t o the ophthalmoplegic side in the Tolosa-Hunt episodes. Systemic symptoms a ssociated with Tolosa-Hunt syndrome, e.g., back pain, chronic fatigue, arth ralgia, gut problems among others, occurred with the same frequency in thes e 10 patients as in an earlier report. Seventy per cent of the patients had signs of inflammation in serum during a period of Tolosa-Hunt syndrome. Or bital phlebograms showed pathologic signs in four of the five patients inve stigated during a Tolosa-Hunt period. One phlebogram was normal in a sixth patient when performed during a period of unilateral periocular pain withou t ophthalmoplegia. Magnetic resonance imaging of the head (with contrast) w as only performed in three patients during the Tolosa-Hunt period: one show ed signs of inflammation in the middle fossa and two were normal. In one of the patients with normal magnetic resonance imaging, the orbital phlebogra m was pathologic. Steroid treatment promptly relieved the pain in all patie nts.