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Dewa Putu Gede Purwa Samatra
Bagian Neurologi Fakultas Kedokteran Universitas Udayana/ Rumah Sakit Umum Pusat Sanglah Denpasar Bali
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Other

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Chronic Granulomatous Tolosa-Hunt Syndrome (Case Report) Samatra, D. P.; Kesanda, I M. P.; Indrayani, I. A. A.
BALI MEDICAL JOURNAL Vol 5 No 1 (2016)
Publisher : BALI MEDICAL JOURNAL

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Abstract

Background: Tolosa-Hunt syndrome is a rare case, characterized by tenderness, persistent around the affected eye and ophthalmoplegia /paresis caused by granulomatous inflammation in the cavernous sinus region, supra orbital or orbital fissure. Although spontaneous remission may occur, even corticosteroid therapy has a very satisfactory effect. However, relapse can occur after remission. We report a case of granulomatous Tolosa-Hunt syndrome in women aged 47 years who suffer from recurrent Tolosa-Hunt syndrome attacks for 4 years on his left eye, there was a significant recovery after receiving steroid therapy. Case: We report A 47 years old with recurrent pain in the left eye since 4 years, pain episode duration of 1-2 weeks, accompanied by double vision when having long or short distance viewing, and when climbing stairs. The patient left eye was protruded with blurred vision and difficulty in distinguishing green color. Left eye examination vision 1/300, green color discromatopsia, normal funduscopic, ptosis, with paresis eye movement toward the superior, inferior, nasal and temporal. C-reactive protein and erythrocyte sedimentation rate were slightly elevated. ANA test was positive. In visual evoked potential, it showed latency elongation of the left face. Head MRI with contrast showed a isointense protrusion on the left cavernous sinus in axial cuts in T1 and T2. Head MRI T1 with contrast on coronal, axial cuts showed the appearance of convex lesions around the left cavernous sinus that enhanced with contrast. Conclusions: The result was clinically and radiographically diagnosed as Tolosa-Hunt Syndrome (THS). Therefore, 10 mg dexamethasone therapy, 4 times a day for 3 days was lowered to three times on day 4, 2 times on the fifth day and one time at day 6. The patient showed clinical improvement. The patient continued 48 mg oral methylprednisolone therapy up to 3 weeks which then gradually decreased and planned head MRI 3 months later.
Co-Authors Agus Antara, Agus Anak Agung Ayu Meidiary Anak Agung Ayu Putri Laksmidewi Anak Agung Ayu Suryapraba Anak Agung Bagus Ngurah Nuartha Anak Agung Gede Sudewa Djelantik Asrul Sani Astari Arum Cendani Goller Bagus Komang Satriyasa Bagus Ngurah Mahasena Putra Awatara Bhaskoro Adi Widie Nugroho, Bhaskoro Adi Widie Candida Isabel Lopes Sam Devi, Gusti Ayu Putu Giti Livia Dewa Putu Wisnu Wardhana Dyah Esti Pranwengrum Fitratun Najizah Haditya, Yogi I Dewa Ayu Inten Dwi Primayanti I Dewa Putu Sutjana I Gusti Ayu Widianti I Gusti Ngurah Ketut Budiarsa I Ketut Suastika I Ketut Sumada I M. P. Kesanda, I M. P. I Made Krisna Dinata I Made Oka Adnyana I Nyoman Adi Putra I Nyoman Mangku Karmaya I Putu Eka Widyadharma I Putu Gede Adiatmika I Putu Gede Wikandikta I. A. A. Indrayani, I. A. A. Ida Ayu Sri Indrayani Ida Ayu Sri Wijayanti Indra Lesmana Ketut Widyastuti Kumara Tini Lely Setyawati Kurniawan Lim, Demetria Jesica Luh Ita Mahendrayani Luh Made Indah Sri Handari Adiputra Luh Putu Ratna Sundari M. Irfan Muhammad Irfan Muhammad Ruslan Nuryanto Mutiah Munawarah Nadya Bianca Ni Ketut Candra Wiratmi Ni Made Linawati Ni Nyoman Ayu Dewi Ni Nyoman Ayu Dewi Ni Putu Winda Apriyanti Ni Wayan Tianing Nitaya Putri Nur Hidayat Nuri Putri Ayu P, Sukarini Pristanova Larasanti Purna Putra IGN Putra IGN, Purna Putri Eka Pradnyaning Putu Agus Grantika, Putu Agus Putu Gede Sudira Putu Lohita Rahmawati Rizki Novrianti S. Indra Lesmana Sawitri, Anak Agung Sagung Sri Yenni Trisnawati Sugijanto - Sugijanto - Sugijanto Sugijanto Sukarini P Suryamulyawan, Kadek Adi Susy Purnawati Syahmirza Indra Lesmana TATI NURHAYATI Thomas Eko Purwata Tjokorda Gde Bagus Mahadewa Tri Wahyu Wulandari Trisa Permata Suhadi Trisha Anindya Trisha Indah Paramita Trisnawati, Sri Yenni Valentina Tjandra Dewi Valentina Tjandra Dewi Virny Dwiya Lestari Wahyuddin, Wahyuddin Wayan Westa Winda Haeriyoko Yusuf Nasirudin