Abstract

The Tolosa-Hunt syndrome(THS) is a syndrome of painful ophthalmoplegia which is caused by a lesion in the cavernous sinus. A 41-year-old man presented a diplopia and left retroorbital pain. Neurologic examination showed a left 6th cranial nerve palsy. The 6th cranial nerve palsy was improved after steroid pulse therapy. About two months later, left 3rd, 4th, and 6th cranial nerve palsies were developed. Brain MRI showed a soft tissue change in the region of the left cavernous sinus and superior orbital fissure. The abnormality was seen as an isosignal intensity on T1 weighted image and high signal intensity on T2 weighted image. There was mild enhancement of the abnormal area after intravenous gadolinium injection. Cranial nerve palsies and retroorbital pain were improved by steroid pulse therapy again. After about 3 months later from the first symptom onset, a retroorbital pain without cranial nerve palsy was developed. The pain was relieved after steroid therapy. During the low dose steroid maintenance therapy after the second recurrence, left periorbital abscess was developed. With antibiotics therapy, the retroor- bital pain and swelling were improved, but the visual acuity was diminished to blindness on the affected side. The lesion of the cavernous sinus was slightly enlarged to ipsilateral orbital apex on the follow up MRI. We report a case of relapsing THS accompanied by orbital abscess. Korean Journal of Headache 5(1):98-101, 2004