Meningioma presenting as Tolosa-Hunt syndrome.

Abstract

A 23-year-old woman was admitted with headache, nausea, vomiting and blurred vision on the left side. Neurological examination showed ptosis with a complete internal and external ophthalmoplegia and a red fullness around the left orbita. Computed tomographic scanning of the brain revealed no abnormalities. As she improved on high doses of steroids a diagnosis of Tolosa-Hunt syndrome (THS) seemed to be indicated. However, magnetic resonance imaging (MRI) showed a lesion with intermediate signal intensity in the left cavernous sinus. Craniotomy was performed when symptoms of THS recurred. Histopathological examination revealed a meningioma with a papillary aspect and some mitoses. This case illustrates that: (1) THS is still a diagnosis by exclusion; (2) MRI and histopathological examination are important if there is any doubt about the diagnosis; and (3) also when there is no doubt, improvement after steroid therapy may be a diagnostic pitfall. Therefore, not only MRI but also orbital phlebography and angiography should seriously be considered.

• Authors: C T Leijzer, R L Prevo, G Hageman
• Journal: Clinical neurology and neurosurgery (Clin Neurol Neurosurg) Vol. 101 Issue 1 Pg. 19-22 (Mar 1999) ISSN: 0303-8467 [Print] Netherlands
• PMID: 10350198 (Publication Type: Case Reports, Journal Article)

Chemical References

• Contrast Media
• Gadolinium DTPA

Topics

• Adult
• Brain Neoplasms (complications, pathology, therapy)
• Combined Modality Therapy
• Contrast Media
• Craniotomy
• Diagnosis, Differential
• Female
• Gadolinium DTPA
• Hematoma (diagnosis)
• Humans
• Magnetic Resonance Imaging
• Meningioma (complications, pathology, therapy)
• Neoplasm Invasiveness
• Ophthalmoplegia (diagnosis, etiology)
• Paranasal Sinus Diseases (diagnosis)
• Sella Turcica (pathology, radiation effects, surgery)