A Case of A Rare Unilateral Headache: A Clinical Case Study
Author(s): MINA MIRZAD, SAEED SEPEHRY VAFA, AMIR RAHIMI, MOHAMAD REZA AYOUBPOUR, LEYLA BHADORIZADEH
Purpose: To report a rare case of unlilateral headache and ophthalmopelgia and its management. The aim of our report is to raise awareness among clinicians about Tolosa-Hunt syndrome as a potential cause of unilateral headaches with symptoms of cranial nerve involvement.
Methods: A 42-year-old man with a history of severe, constraining headaches had subsequent eye movement difficulties. His symptoms quickly escalated to include double vision and restricted eye movement, compounded by significant swelling and erythema around his eye. A brain and orbital MRI (Magnetic Resonance Imaging) revealed significant thickening of the left cavernous sinus, in addition to pachimeningeal thickening in the left Meckel’s cave and nearby dural thickening.
Results: The patient exhibited dysfunction of the left optic (II), abducens (IV), oculomotor (III), trochlear (IV), ophthalmic branch of the trigeminal nerve (V), and MRI abnormalities that satisfy the diagnostic criteria for THS. The patient was prescribed prednisolone, which significantly improved headache and ptosis after 72 hours, and cranial nerve palsies improved within two weeks. After a year, no headaches or ophthalmia recurred.
Conclusion: This case report describes an infrequent presentation and is important because the symptoms of this syndrome can be similar to those of other clinical conditions, and a definitive diagnosis can only be made through appropriate imaging or a biopsy. The need to get biopsy or MRI data before confirming a diagnosis of THS has been emphasized by the most recent guidelines
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