A comparison of benign and inflammatory manifestations of Tolosa-Hunt syndrome

Abstract

Background: Tolosa-Hunt syndrome (THS) manifests as a benign or an inflammatory type disease. The nosography differences between these types remain to be elucidated. We aimed to analyze and compare the clinical presentations of benign and inflammatory THS. Methods: The ward patients who presented with THS from January 1990 to May 2011 were retrospectively reviewed. THS was diagnosed according to the recommendations of the International Headache Society. Results: Of the 53 THS cases (49 patients), 30 (56.6%) were classified as benign and 23 (43.4%) as inflammatory THS. There were strong similarities between the groups in terms of clinical manifestations, laboratory findings, responses to glucocorticoid treatment, and outcomes. However, patients with inflammatory THS tended to be younger (mean age, 43.4 years; p<0.05) and have optic nerve dysfunction (56.5%; p<0.05) and longer disease duration (2.3±1.0 months; p<0.05) compared to those with benign THS (mean age, 56.4 years; mean disease duration, 1.6±0.7 months). The patients with additional involvement of both the optic nerve and the second division of the trigeminal nerve experienced a longer disease duration (p<0.05). Additionally, patients with orbital pseudotumors had diplopia that responded poorly to treatment with glucocorticoids (p<0.05). High-dose (>0.5 mg/kg/day) and low-dose (≥0.5 mg/kg/day) prednisolone were equally effective in relieving symptoms in both groups (p>0.05). Conclusion: Benign and inflammatory THS were highly similar in terms of nosography. The responses to glucocorticoid treatment were generally good except in patients with orbital pseudotumors. © 2013 International Headache Society.