Inflammatory pseudotumor of the cavernous sinus, Tolosa-Hunt syndrome and facial nerve: What is the relationship?
DOI:
https://doi.org/10.34631/sporl.784Keywords:
pseudotumor, Tolosa-Hunt syndrome, facial nerve, cavernous sinusAbstract
Clinical case: the authors present a case of a 51-year-old woman with a history of right palpebral ptosis and binocular vertical diplopia. The initial imaging study showed a nonspecific focal increase of the right lateral wall of cavernous sinus. Laboratorial investigation and electromyographic analysis were normal. Symptoms were promptly controlled with high doses of steroid therapy. One year later, during withdrawal from steroid therapy, she presented in emergency department with headache, right peripheral facial palsy and right otalgia. A new imaging study showed contrast enhancement over the right facial nerve, as well as thickening of the left cavernous sinus and oculomotor nerve; the right cavernous sinus showed normal morphology. The most probable diagnosis was an alternant inflammatory pseudotumor of the cavernous sinus; some of these cases are compatible with Tolosa-Hunt syndrome. A unique feature that is pathognomonic for this syndrome does not exist and, although rare, facial nerve involvement has already been reported.
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