Tolosa-Hunt syndrome relapse during pregnancy following chronic intake of combined oral contraceptives

Abstract

Tolosa-Hunt syndrome (THS) is a rare syndrome of painful ophthalmoplegia secondary to an idiopathic granulomatous inflammation affecting the cavernous sinus, superior orbital fissure or orbit. Pregnancy and pregnancy-related hormones have been identified as potential triggers. A 39-year-old gravida-2 para-1 woman with prior chronic intake of combined oral contraceptives (COC) suffered two episodes of painful ophthalmoplegia-the first event with spontaneous remission and the relapse occurring during pregnancy and with complete resolution following steroid treatment. MRI revealed a postinflammatory mass at the junction of the left orbital apex and anterior cavernous sinus, supporting the diagnosis of THS. To our knowledge, this is the first report of a THS relapse occurring during pregnancy following a chronic history of COC intake. This case adds to the growing evidence supporting the relationship between immune and hormonal factors that may be present during pregnancy and the disease pathogenesis of THS.

Keywords: headache (including migraines); neuroopthalmology; pregnancy.

Figure 1

(A) T1-weighted non-contrast, (B) T1-weighted contrast and (C) T2-weighted brain MRI images in axial cuts showing the postinflammatory mass lesion (arrow) at the junction of the left orbital apex and anterior cavernous sinus. Images were generated using a gadolinium-based contrast agent.