Tolosa-Hunt syndrome preceded by facial palsy

The Tolosa-Hunt syndrome consists of a painful ophthalmoplegia related to a granulomatous inflammatory process in the cavernous sinus, which may be do cumented by cerebral magnetic resonance imaging with gadolinium enhancement . Two cases of Tolosa-Hunt syndrome preceded by facial palsy observed in 1998 at the Department of Neurosurgery of the Second University of Naples are p resented here. Both patients developed Tolosa-Hunt syndrome following an ip silateral facial palsy that resolved in about 15 days with medical treatmen t. Cerebral magnetic resonance imaging with gadolinium enhancement showed, in both cases, inflammatory tissue in the cavernous sinus. The patients und erwent corticosteroid therapy (prednisolone, 80 mg per day, intravenously) with pain regression. In the first case, the patient experienced recurrence of the syndrome that was definitively resolved with further corticosteroid treatment. The rare reports of facial palsy in patients with Tolosa-Hnnt syndrome sugg est the inclusion of this disease in the so-called multiple cranial nerve p alsy syndrome. It is probable that Tolosa-Hunt syndrome has an inflammatory pathogenesis.