MRA demonstration of periarteritis in Tolosa-Hunt syndrome

• Published in: Acta neurochirurgica Vol. 143; no. 3; pp. 309 - 312
• Main Authors: OZAWA, T, MINAKAWA, T, SAITO, A, YONEOKA, Y, YOSHIMURA, J, ARAI, H
• Format: Journal Article
• Language: English
• Published: Wien Springer 01.01.2001; New York, NY Springer Nature B.V
• Subjects: Biological and medical sciences; Cavernous Sinus - pathology; Diseases of visual field, optic nerve, optic chiasma and optic tracts; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Medical research; Medical sciences; Middle Aged; Ophthalmology; Polyarteritis Nodosa - diagnosis; Predictive Value of Tests; Tolosa-Hunt Syndrome - diagnosis; Human; Nervous system diseases; Cardiovascular disease; Nuclear magnetic resonance imaging; Arteritis; Arterial disease; Vascular disease; Case study; Eye disease; Cranial nerve disease; Pain; Medical imagery; Adult; Female; Diagnosis; Oculomotor syndrome; NMR angiography; Painful ophthalmoplegia
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s007010170112

Modern magnetic resonance imaging (MRI) diagnosis of Tolosa-Hunt syndrome rests upon demonstration of cavernous sinus abnormalities. We present a case of Tolosa-Hunt syndrome who has no abnormal mass lesion in the cavernous sinuses on MRI but with a diagnostic lesion on magnetic resonance angiography (MRA). A 48-year-old woman developed acute periorbital pain and abducens palsy of the right side at the first episode, and subacute peri-orbital pain and rapidly deteriorating visual acuity on the left side at the second episode with a four months interval. MRI showed no soft-tissue abnormality in the cavernous sinuses. MRA demonstrated a narrowing of the right cavernous carotid artery at the first episode, and narrowings of the left clinoid carotid and ophthalmic arteries at the second episode. Based on these findings, the patient underwent urgent steroid therapy and the symptoms resolved dramatically in each episode. Follow-up MRA confirmed resolution of arterial narrowings. MRA may help prompt the noninvasive diagnosis in certain cases of Tolosa-Hunt syndrome with little inflammatory reaction in the cavernous sinus but with predominant intra- and juxta-cavernous periarteritis.