Tolosa-Hunt syndrome A radiation responsive syndrome

The Tolosa-Hunt syndrome is a clinical entity characterized by retro-orbital pain and variable involvement of the third, fourth, fifth and sixth cranial nerves related to inflammation in the cavernous sinus. Typically, this syndrome is responsive to steroids and most attacks are self-limited. However, occasional patients will have prolonged courses and become steroid dependent. A case is presented in which the patient developed significant toxicity from chronic steroid dependency. Because of the similarities between the Tolosa-Hunt syndrome and orbital pseudotumor, a course of low-dose radiation therapy was prescribed which allowed the patient to be withdrawn from steroids. The rationale for the treatment of selected patients with the Tolosa-Hunt syndrome with low-dose radiotherapy is discussed. This is the second reported case in the world's literature of the Tolosa-Hunt syndrome being successfully treated with radiotherapy.