Isolated Complete-Pupil Involved- Third Nerve Palsy as Presentation of Tolosa-Hunt Syndrome: Case Report

Tolosa-Hunt syndrome (THS) is a rare, painful ophthalmoplegia associated with paresis of one or more of the third, fourth and/or sixth cranial nerves that in some uncommon cases dysfunction of the optic, trigeminal, facial, acoustic nerves and sympathetic innervation of the pupil can be seen. THS is a diagnosis of exclusion and treatment should be with high dose steroid. Case presentation: We describe the case of a 55-year-old Egyptian male that was admitted to our hospital for painful ophthalmoplegia of the right eye. After the diagnostic work-up, we concluded that the patient had an inflammatory form of Tolosa-Hunt syndrome. We initiated treatment with IV steroids and showed great response. Discussion: The etiologies of headache in association with third cranial nerve palsy—pupillary involvement are: Tolosa-Hunt syndrome (THS), recurrent painful ophthalmoplegic neuropathy (RPON) formerly named ophthalmoplegic migraine (OM), posterior communicating artery aneurysms (PCAs), pituitary apoplexy. Conclusion: Finally, we concluded that the patient had Tolosa-Hunt syndrome because he completely fulfilled HIS 2018 diagnostic criteria, and the treatment with steroids at a dose of 1 mg/kg/day tapered slowly and has been well received.