Tolosa-Hunt Syndrome Preceded by Facial Palsy in a Child

• Published in: Pediatric neurology Vol. 44; no. 1; pp. 61 - 64
• Main Authors: Cerisola, Alfredo, MD, González, Gabriel, MD, Scavone, Cristina, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2011; Elsevier
• Subjects: Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Cavernous Sinus - pathology; Child; Cranial Nerve Diseases - complications; Cranial Nerve Diseases - drug therapy; Cranial Nerve Diseases - pathology; Diplopia - etiology; Facial Paralysis - complications; Facial Paralysis - pathology; Headache - etiology; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Pediatrics; Prednisone - therapeutic use; Tolosa-Hunt Syndrome - complications; Tolosa-Hunt Syndrome - drug therapy; Tolosa-Hunt Syndrome - pathology; Tomography, X-Ray Computed; Human; Nervous system diseases; Motor system disorder; Facial paralysis; Facial nerve; Eye disease; Cranial nerve disease; Pain; ENT disease; Oculomotor syndrome; Neurological disorder; Child; Painful ophthalmoplegia
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2010.08.018

We report on a previously healthy 11-year-old boy with unilateral periorbital mild headache and facial nerve palsy, followed during the next 5 months by recurrent unilateral headaches and subsequent extrinsic paresis of the third cranial nerve and paresis of the sixth cranial nerve, each of which improved with steroids. Cranial magnetic resonance imaging revealed increased thickening of the left cavernous sinus and adjacent structures, with marked gadolinium enhancement. Eight months after the initial signs, he developed left retro-orbital headache that lasted 16 days and was relieved 24 hours after resuming steroid treatment. Recurrent multiple cranial neuropathies, neuroimaging findings, and long-lasting headache that responded to steroids indicated Tolosa-Hunt syndrome, further confirmed by extensive investigation and a long follow-up to exclude other causes. This patient illustrates the complexity of disorders with multiple cranial nerve palsies, and adds to the sparse literature on Tolosa-Hunt syndrome in children, describing the first pediatric case preceded by facial palsy.