We report a case with recurrent orbital
pain and unilateral cranial nerve
paresis mimicking
Tolosa-Hunt syndrome. However, these features were most likely caused by
bacterial infection because of beneficial response to
antibiotics therapy. A 32-year-old man developed severe right orbital
pain and
diplopia. Neurological examination revealed right oculomotor
paresis and 1st division of the right trigeminal nerve dysfunction. MR imaging revealed thickness of right cavernous sinus region with marked
gadolinium enhancement. Cerebrospinal fluid (CSF) examination was initially normal. Treatment with
steroid showed marked improvement. However soon after tapering of
steroid dosage, his symptoms recurred and deteriorated. He was referred to our hospital because of second opinion. Neurological examination still showed right oculomotor
paresis and 1st division of the right trigeminal nerve dysfunction with orbital and retro-orbital
pain. Re-examination of CSF showed
pleocytosis with neutrocytes dominancy and elevated
protein concentration. Intravenous treatment with
penicillin was initiated with marked improvement. There have been reported cases with
bacterial infection resulting pseudo
Tolosa-Hunt syndrome, which have good response to
antibiotics treatment with excellent prognosis. It is speculated that
bacterial infection might cause clinical features mimicking
Tolosa-Hunt syndrome in our case.