El síndrome de Tolosa-Hunt se presenta como oftalmoplejía dolorosa — dolor orbitario o periorbital severo combinado con paresia de nervios craneales que causa alteración del movimiento ocular. La prioridad clínica es una intervención rápida y eficaz para abordar tanto el dolor como el déficit motor.
La terapia con corticosteroides es la piedra angular establecida del tratamiento de primera línea para el síndrome de Tolosa-Hunt. El régimen estructurado completo — que abarca la selección del agente, los detalles de administración y la secuenciación — se encuentra disponible en el protocolo completo.
Los objetivos principales son la resolución del dolor orbitario y periorbital y la recuperación de la oftalmoplejía (paresia). Con una terapia corticosteroidea adecuada, se espera una respuesta clínica significativa en 48 horas.
DOI: 10.4236/ym.2020.42014
Generally corticosteroid therapy such as prednisolone (PSL), methylprednisolone (mPSL) and dexamethasone, given either orally or intravenously for THS results in climactic improvement in pain which is usually apparent in a few days, notwithstanding the fact that corticosteroids are the cornerstone of treatment for THS, there are controversies concerning effective course, route of administration, optimal dosage, period of therapy and treatment in special groups such as pregnant women and children, a case with fastest recovery has been portrayed in a young male with retro obital pain and ocular motilities resolving in 12 hours of the first high dose IV mPSL of 500 mg BID for 3 days and nearly absolute normalization in 4 days and kept on 7 days daily maintenance dose of prednisone 60 mg.
Finally, Lawton Smith and David Taxdal in 1966 added five cases on top of the cases reported by Dr. Tolosa and Hunt et al. to initiate the use of the term THS as the painful ophthalmoplegia associated with CN paralysis that responded to corticosteroid treatment in 48 hours.
The pain and paresis should eventually resolute with adequate corticosteroids therapy and shouldn't be outshined by other ICHD-3 diagnoses.