Abstract
Tolosa-Hunt syndrome (THS) is characterized by unilateral ophthalmoplegia due to non-specific granuloma in the cavernous sinus. Steroid therapy is effective against THS. We report a case of malignant lymphoma showing symptoms similar to THS subsequent to paresthesia of the third division of the trigeminal nerve.
The patient was a 56-year-old man who presented with paresthesia of the third division of the trigeminal nerve region. On initial examination, there were no radiographic or computed tomographic abnormalities of the head and neck region, including the cavernous sinus. After 2 weeks, highly enhanced images were observed in the cavernous sinus on magnetic resonance imaging (MRI), and the patient complained of ophthalmoplegia and neuralgia of the first and second division of the trigeminal nerve region. Daily administration of steroids improved symptoms. THS was suspected on the basis of neurological symptoms, MRI findings, and the response to steroids. Symptoms recurred after 2 months. Bone marrow puncture was performed, and acute lymphatic leukemia (ALL-L 3, Burkitt type) was finally diagnosed. Eighteen months after the first examination, the patient died. Autopsy was done, and a malignant lymphoma arising in the cavernous sinus was confirmed.
We reported a case in which paresthesia of the third division of the trigeminal nerve region was an initial manifestation of the Tolosa-Hunt syndrome.
