A case of headache, double vision and ptosis in emergency department: Tolosa-Hunt syndrome

Ataman Kose; Seyran Bozkurt; Sermin Tok Umay; Serkan Karakulak; Arda Yilmaz

doi:10.1016/j.tjem.2017.10.004

Ataman Kose¹, Seyran Bozkurt¹, Sermin Tok Umay², Serkan Karakulak¹, Arda Yilmaz³

¹Mersin University, Faculty of Medicine, Department of Emergency Medicine, Mersin, Turkey
²Mersin University, Faculty of Medicine, Department of Radiology, Mersin, Turkey
³Mersin University, Faculty of Medicine, Department of Neurology, Mersin, Turkey

Keywords: Headache, Double vision, Ptosis, Steroid treatment

Abstract

Headache and double vision symptoms can be seen especially neurological and optical problems. We present Tolosa-Hunt syndrome in a 34-year-old female patient who presented to the emergency department (ED) with the complaints of unilateral severe headache, double vision and ptosis, presented asymmetric contrast enhancement in the right superior cavernous sinus on MR. This pain was reduced with steroid therapy. Pulse steroid therapy of 1 mg/kg/day was planned based on the patient's clinical manifestation, MRI findings and presumed diagnosis of THS. It was observed at patient's follow-up that there were occasional headache, ptosis and double vision were disappeared and MRI findings were regressed.

In the differential diagnosis of patients presenting to the ED with the complaints of headache and double vision, rare pathologies such as THS should be considered in addition of common pathologies such as neurological and ocular diseases.