Tolosa-Hunt syndrome with reversible dissection aneurysm

Abstract

A 49-year-old female presented with recurrent intolerable right retro-orbital pain, ptosis and diplopia for 4 months. Neurological evaluation revealed right oculomotor nerve and abducent nerve injuries. Neuroimaging found enlarged right cavernous sinus, right intracavernous carotid dissection aneurysm and a stenosis proximal to it. Tolosa-Hunt syndrome (THS) was suggested and treated with steroid. The clinical symptoms were alleviated after the treatment. After 3 months of follow-up cerebral angiography showed the lesions of the right intracavernous carotid stenosis and the dissection almost disappeared. Therefore, we proposed that the dissection and the stenosis are directly induced by the inflammation of THS.