A 48-year-old woman was referred to the First Dept. of Int. Med., Nagasaki Univ. Sch. Med., in August, 1979, with a six-month history of recurrent episodes of right-sided
painful ophthalmoplegia and
diplopia. An epidode affected the right eye, lasted one to two weeks, and relapsed every month. On examination she had a complete ptosis on the right side and
pain on the right eye. All extraocular muscle supplied by the 3rd nerve were paralysed. The pupils were equal in size both sides, reacting to light completely. Visual acuity was normal except
myopia. All the other cranial nerves and the remainder of central nervous system was normal. Results of thyroid function tests and of lumbar puncture were normal. The
glucose tolerance test showed a mild diabetic pattern. Blood and CSF cultures for bacteria, fungi, and
acid-fast bacillus were negative. The skull, brain CT scan, and carotid angiogram were within normal limits. A tentative diagnosis of
Tolosa-Hunt syndrome was made after an unproductive search for a cause for this woman's
painful ophthalmoplegia and unsuccessful treatment of
ophthalmoplegia with
antibiotics or
diet therapy for mild
hyperglycemia. The patient was given
prednisolone 30 mg daily orally when she had the 9th attack of
painful ophthalmoplegia Pain, ptosis, and
diplopia disappeared in 5 days and she did not show any recurrence of symptoms over the next 7 months.