H Doðru

K Akpýnar

L Ýncesu

T Özbenli

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POSTER PRESENTATION Open Access
Tolosa-Hunt syndrome: focus on MRI findings
and diagnostic criteria
T Özbenli1*, K Akpýnar2, H Doðru2, L Ýncesu1
From The European Headache and Migraine Trust International Congress
London, UK. 20-23 September 2012
Introduction
Tolosa-Hunt Syndrome(THS) is a rare disorder charac-
terized by periorbital or hemicranial pain, ipsilateral ocu-
lumotor paralysis and prompt response to steroids [1,2].
Purpose/background/objectives
The etiology of THS is still unknown [3]. According to the
diagnostic criteria demonstration of the presence of granu-
loma through MR imaging and/or biopsy is mandatory for
diagnosis. The initial standard MR imaging may not be
sufficient for diagnosis.
Methods
According to the criteria revised in 2004 by the Interna-
tional Headache Society, seven cases diagnosed as THS
have been assessed from the perspectives of type, age,
symptoms and findings, accompanying diseases, MRI
techniques used, localization of the determined lesion,
response to the treatment and clinical progress. Routine
biochemical tests, cranial MRI and CT angiographies
were done on each patient, and lumbar puncture were
also carried out on four.
Results
Four of seven cases diagnosed are males. Age average of
patients is 45,7 + 18,1 (25-69). In three of seven cases,
cranial nerve paralysis of the third, in one case the fourth,
another in sixth, two with fifth, and one with seventh
nerve, and in two cases the third, fourth and/or sixth cra-
nial nerves were determined to be bunched. In all cases a
response was obtained within 24-72 hours to the corticos-
teroid treatment. Four out of seven cases had recurrence.
Conclusion
Dynamic contrast enhanced MRI may be necessary to
demonstrate the presence of granuloma. THS is a diagnosis
of exclusion requiring careful patient evaluation to rule out
vascular causes, tumour, or other forms of inflammation in
the region of the cavernous sinus. In some cases, even
though MRI is normal, the most logical diagnosis is THS.
Patients categorized in this group may be as diagnosed as
“probable THS” and follow-up at least two years until the
necessary MRI methods are clearly defined in the IHS
diagnostic criteria.
Author details
1Ondokuz Mayýs University, Turkey. 2Ondokuz Mayýs University, UK.
Published: 21 February 2013
References
1. Le Mantia I, Curone M, Rappaport am: Tolosa Hunt syndrome critical
literature rewiew based on 2004 criteria. Cephalalgia 2006, 26:772-781.
2. Colnaghi S, Versino M, Marchioni E, et al: ICHD-II diagnostic criteria for
Tolosa-Hunt syndrome in idiopathic inflammatory syndromes of the
orbit and/or the cavernous sinus. Cephalalgia 2008, 577-584.
3. Kline LB, Hoyt WF: The Tolosa-Hunt syndrome. J Neurol Neurosurg
Psychiatry 2001, 71:577-82.
doi:10.1186/1129-2377-14-S1-P157
Cite this article as: Özbenli et al.: Tolosa-Hunt syndrome: focus on MRI
findings and diagnostic criteria. The Journal of Headache and Pain 2013
14(Suppl 1):P157.
1Ondokuz Mayýs University, Turkey
Full list of author information is available at the end of the article
Özbenli et al. The Journal of Headache and Pain 2013, 14(Suppl 1):P157
http://www.thejournalofheadacheandpain.com/content/14/S1/P157
© 2013 Özbenli et al; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.


Tolosa-Hunt syndrome: focus on MRI findings and diagnostic criteria

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Tolosa-Hunt syndrome: focus on MRI findings and diagnostic criteria

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