A case of
fungal aneurysm associated with presumed
Tolosa-Hunt syndrome is reported. A 57-year-old man was admitted to our hospital with complaints of left
blepharoptosis,
headache and
weight loss. Neurological examination revealed left
ophthalmoplegia without facial
hypesthesia. Visual acuity was normal. Laboratory studies showed raised ESR, 4+
glycosuria, and a
blood sugar of 351mg/dl. Computerized tomography (CT) scan and left carotid angiography were considered normal. Left orbital venography showed no filling of the left cavernous sinus. Diabetic
ophthalmoplegia was suspected by a neurologist. The patient was treated with
insulin therapy, but visual acuity worsened, and
hypesthesia was noted in the first and second divisions of the left trigeminal nerve. Subsequent CT scan demonstrated a high density lesion, which was homogeneously enhanced, in the left cavernous portion and the superior orbital fissure. The patient was presumed of
Tolosa-Hunt syndrome, and prednine
therapy (30mg/day) was started. On the second day after the administration of prednine,
hypesthesia of the first and second division of the left trigeminal nerve improved. After 9 days of prednine
therapy, the patient suddenly complained of severe
headache, and lapsed into a
coma. Massive
hemorrhage with
subarachnoid hemorrhage was recognized on the CT scan, with a marked midline shift to the right. The
hematoma was immediately removed. A ruptured
cerebral aneurysm was found at the bottom of the
hematoma. The
aneurysm was located in the distal portion of the left middle cerebral artery.
Aneurysm clipping with external
decompression and bilateral ventricular drainage was performed.(ABSTRACT TRUNCATED AT 250 WORDS)