THE VALUE OF MRI IN A CASE OF TOLOSA-HUNT-SYNDROME

We report a case of Tolosa-Hunt syndrome (THS) in which the lesion has been demonstrated by magnetic resonance imaging (MRI), computed tomog raphy (CT), and angiography. A healthy 23-year-old man developed an ac ute painful ophthalmoplegia on the right side. CT and MRI scans reveal ed asymmetric enlargement of the right cavernous sinus with contrast e nhancement extending down to the region of trigeminal ganglion. MRI fu rther delineated the detailed anatomical structures of the region and excluded any infiltration of the surrounding tissues by a mass lesion. Cerebral angiography showed a significant decrease in the calibration of petrous segment and a mild decrease in the calibration of cavernou s segment of the ipsilateral internal carotid artery. The patient was treated with oral prednisone, 100 mg daily. Neurological findings tota lly subsided after 2 weeks on corticosteroid and MRI showed resolution of the lesion in the cavernous sinus. The patient was symptom-free fo r 6 months after discharge. Our findings have suggested that MRI is th e most valuable imaging technique for demonstration and follow-up of l esions in the cavernous sinus that are directly responsible for the sy mptoms of THS and the lesions can be more extensive than was currently believed. (C) 1997 Elseveier Science B.V.