Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Images in Neurosciences
10 (
3
); 504-505
doi:
10.1055/s-0039-1697245

Optic Perineuritis in a Case of Tolosa–Hunt Syndrome

Department of Ophthalmology, Kasturba Medical College, Mangalore; Manipal University of Higher Education (MAHE), Manipal, Karnataka, India
Department of Internal Medicine, Kasturba Medical College, Mangalore; Manipal University of Higher Education (MAHE), Manipal, Karnataka, India
Address for correspondence Teena Mariet Mendonca, MS Department of Ophthalmology, Kasturba Medical College Hospital Attavar, Mangalore 575001, Karnataka India tmendonca87@gmail.com
Licence
This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers and was migrated to Scientific Scholar after the change of Publisher.

A 50-year-old woman presented with the complaints of recurrent episodes of right hemicranial headache for 7 months with binocular diplopia for 1 month. Headache was severe in nature with shooting type of right periorbital and retro-orbital pain. On examination, her visual acuity was 20/20 for distance and N6 for near in both eyes. She had complete ptosis and total ophthalmoplegia of the right eye. Right-eye pupil was 4 mm dilated and fixed. Left-eye pupil was 2 mm reacting to light. Fundus examination showed optic disc edema in the right eye. We arrived at a clinical diagnosis of total ophthalmoplegia with orbital apex syndrome on the right side. Her visual field examination (Humphrey 30–2) was normal in both eyes. Magnetic resonance imaging (MRI) study orbits (plain) showed ill-defined T1 and T2 isointense areanoted in the right orbital apex and superior orbital fissure. Contrast-enhanced MRI orbit images (Fig. 1A) showed right optic nerve sheathenhancement predominantly in the orbital apex. Coronal sections showed "doughnut-"shaped enhancement, and axial sections showed "tram track" enhancement (Fig. 1B) around the optic nerve suggestive of optic perineuritis. She underwent extensive workup to rule out autoimmune and infective conditions. The patient was diagnosed with Tolosa–Hunt syndrome with optic perineuritis. She was treated with intravenous methylprednisolone 1 g/day for 5 days followed by oral prednisolone 1 g/kg body weight with a slow taper. Dramatic improvement in her symptomswas noted within 48 hours of steroid administration. She was relieved of headache and diplopia. Her extraocular motility improved significantly, and disc edema resolved after a week of starting steroids.

Fig. 1 Contrast-enhanced magnetic resonance imaging brain with orbits (T1-weighted image) axial section (A) showing ill-defined homogenously enhancing area noted in the right orbital apex. "Tram track" enhancement (arrow) of the optic nerve sheath in the axial section and "doughnut-"shaped enhancement (arrow) in the coronal section (B) can be noted.

Fig. 1 Contrast-enhanced magnetic resonance imaging brain with orbits (T1-weighted image) axial section (A) showing ill-defined homogenously enhancing area noted in the right orbital apex. "Tram track" enhancement (arrow) of the optic nerve sheath in the axial section and "doughnut-"shaped enhancement (arrow) in the coronal section (B) can be noted.

Tolosa–Hunt syndrome, also called syndrome of painful ophthalmoplegia, is a diagnosis of exclusion. The syndrome results in periorbital or hemicranial pain with ipsilateral paresis of oculomotor nerves due to nonspecific inflammation at the orbital apex or superior orbital fissure.1 Optic perineuritis is an uncommon variant of idiopathic orbital inflammatory disorder, involving the optic nerve sheath and surrounding tissues.2 Contrast-enhanced MRI orbits is the diagnostic modality of choice. Visual outcome after treatment with corticosteroids in patients with optic perineuritis is generally good.3

Conflict of Interest

None declared.

Funding None.

References

  1. , , . The Tolosa-Hunt syndrome. J Neurol Neurosurg Psychiatry. 2001;71(5):577-582.
    [Google Scholar]
  2. , , , . Optic perineuritis: clinical and radiographic features. Arch Ophthalmol. 2001;119(9):1299-1306.
    [Google Scholar]
  3. , , , . Idiopathic inflammatory pseudotumor of the orbit and Tolosa-Hunt syndrome-are they the same disease? J Neurol. 2002;249(9):1237-1241.
    [Google Scholar]

Fulltext Views
535

PDF downloads
103
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections