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  • Title: Tolosa-Hunt syndrome misdiagnosed as sinusitis complication.
    Author: Lachanas VA, Karatzias GT, Tsitiridis I, Panaras I, Sandris VG.
    Journal: J Laryngol Otol; 2008 Jan; 122(1):97-9. PubMed ID: 18198008.
    Abstract:
    OBJECTIVE: Tolosa-Hunt syndrome is a rare condition of painful ophthalmoplegia combined with ipsilateral ocular motor nerve palsies, caused by non-specific granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. A case of Tolosa-Hunt syndrome misdiagnosed as sinusitis orbital complication is reported. CASE REPORT: A patient suffering from left periorbital pain, upper eyelid oedema and ptosis, and horizontal diplopia, diagnosed as sinusitis orbital complication, was referred to our department. Clinical evaluation revealed only a left VIth nerve paresis. Haematological studies, cerebrospinal fluid tests and computed tomography scanning were negative. A magnetic resonance imaging (MRI) scan showed enhancement of the left cavernous sinus. Corticosteroid therapy was commenced, and within three days all symptoms disappeared. A diagnosis of Tolosa-Hunt syndrome was made. Follow-up MRI studies were normal. CONCLUSION: Tolosa-Hunt syndrome, although rare, is a nosological entity that otolaryngologists must bear in mind. Magnetic resonance imaging studies are essential in the diagnosis and follow up of these patients, in order to avoid a mistaken Tolosa-Hunt syndrome diagnosis.
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