Neurology: Case of the Month

Test Yourself — Patient 30

Tolosa Hunt Syndrome

1. All of the following pass through the cavernous sinus, EXCEPT:
   • [ A ] Oculosympathetic fibers
   • [ B ] Carotid artery
   • [ C ] CN VI
   • [ D ] Mandibular division of CN V
2. All of the following are TRUE regarding the Tolosa-Hunt syndrome, EXCEPT:
   • [ A ] The cause is now known to be an unusual mycobacterial agent, responsible for the granulomatous inflammation.
   • [ B ] Treatment with steroids is highly effective in reducing the ocular pain.
   • [ C ] Recurrences have been reported and are not that unusual.
   • [ D ] Involvement of structures outside the cavernous sinus has been reported.
   • [ E ] Patients may be left with permanent neurological deficits.
3. The current diagnostic criteria for Tolosa-Hunt syndrome include all of the following, EXCEPT:
   • [ A ] Retro-orbital or hemifacial pain
   • [ B ] Symptoms that last from days to weeks
   • [ C ] Neurological involvement not confined to CN III
   • [ D ] Evidence of systemic involvement, as from sarcoidosis
   • [ E ] Recurrent attacks are allowed
4. Which of the following may involve the cavernous sinus/superior orbital fissure?
   • [ A ] Tuberculosis
   • [ B ] Meningioma
   • [ C ] Lymphoma
   • [ D ] Sarcoidosis
   • [ E ] Herpes zoster
   • [ F ] A, B, C, and D
   • [ G ] All of the above
5. Which of the following statements regarding the natural history of Tolosa-Hunt syndrome is TRUE?
   • [ A ] The process is progressive unless cared for in a timely fashion and may result in severe neurological impairment or death.
   • [ B ] It is a self-limited disease that leaves no neurological impairment.
   • [ C ] It is a self-limited disease that may recur and may leave permanent neurological sequelae.
   • [ D ] Steroid treatment is not indicated because of the fear of exacerbating a latent mycobacterial infection.

 

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