Unusual clinical course in pediatric Tolosa-Hunt syndrome.

Abstract

We report on a 7-year-old immunocompetent boy initially presenting with right-sided frontal cephalalgia, painful ophthalmoplegia, and ptosis for 1 month. Initial cerebrospinal fluid analysis produced normal results. Magnetic resonance imaging revealed an inflammatory pseudotumor of the right cavernous sinus after intravenous gadolinium administration, indicating a rare idiopathic inflammatory disorder of the cavernous sinus, i.e., Tolosa-Hunt syndrome. Ptosis and cephalalgia resolved after steroid treatment, although right-sided ophthalmoplegia remained. Breakthrough headache, associated with signs of meningeal irritation, developed 6 weeks later. Follow-up contrast-enhanced computed tomography revealed no enhancing cavernous soft tissue mass. A further lumbar puncture disclosed central nervous system infection with Staphylococcus saprophyticus. After 6 weeks of vancomycin, the headache resolved completely, and neuroimaging produced normal results. A diagnosis of Tolosa-Hunt syndrome should be rendered cautiously, because the etiology may involve a rare but not "idiopathic" infection. Moreover, if clinical signs are not fully responsive to steroid treatment, the underlying problems should receive careful investigation.

• Authors: Chia-Hao Kang, Yi-Chuan Huang, Chun-Chung Lui, Ying-Chao Chang, Pi-Lien Hung
• Journal: Pediatric neurology (Pediatr Neurol) Vol. 44 Issue 6 Pg. 471-4 (Jun 2011) ISSN: 1873-5150 [Electronic] United States
• PMID: 21555061 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Topics

• Child
• Humans
• Male
• Meningitis, Bacterial (diagnosis, microbiology, therapy)
• Staphylococcal Infections (diagnosis, microbiology, therapy)
• Staphylococcus saprophyticus
• Tolosa-Hunt Syndrome (diagnosis, microbiology, therapy)