A CASE REPORT: TOLOSA HUNT SYNDROME PRESENTING WITH PAINFUL TRIGEMINAL NEUROPATHY

Abstract

Tolosa-Hunt Syndrome (THS) is a rare idiopathic granulomatous inflammation of the cavernous sinus or superior orbital fissure, leading to unilateral periorbital pain and cranial nerve palsy. It can also cause neuropathic pain in the trigeminal nerve distribution, particularly in the ophthalmic (V1) and maxillary (V2) branches. We report a case of a 68-year-old woman presenting right eye ptosis, medial rectus weakness, right periorbital pain with electric-like quality especially when moving the eyeball and allodynia in the right eye area for the past two months. Contrast-enhanced brain MRI revealed right cavernous sinus thickening. Treatment with Prednisone 60 mg/day for 1 week and Gabapentin 300 mg/day for 1 month resulted in marked improvement of ptosis and pain.