Tolosa-Hunt syndrome is a rare neurological disorder with an incidence of one case per million. It is a granulomatous inflammatory condition that affects the cavernous sinus and is characterized by painful ophthalmoplegia and headaches. We present a 57-year-old male veteran with past medical history of alcohol use disorder, hepatitis c, hypertension and tobacco use who presented with complaints of double vision and headaches for 2 days. The patient also had a history of well controlled cluster headaches treated with sumatriptan. But, he reported that from several days prior to admission, the headaches were getting more frequent, sharp, localized to the left side, and preventing him from sleeping. On physical exam, vitals were stable, the neck was supple, the pupils were equal in size and reactive to light but limited left eye abduction and external rotation were noted. The remainder of physical exam was unremarkable including the remaining cranial nerves. Computerized tomography (CT) head was done which showed no evidence of acute stroke. Magnetic resonance imagining (MRI) brain was performed which showed an asymmetric bulge of the left cavernous sinus which raised suspicion for cavernous sinus inflammation. Systemic high dose steroid trial was given. Patient’s symptoms improved within 72 hours and diagnosis of Tolosa-Hunt Syndrome was confirmed. According to the National Organisation for Rare Disorders (NORD) the average age of onset for this condition is 41 years. The pathogenesis is thought to be inflammation of unknown etiology. The criteria for diagnosis fo Tolosa-Hunt syndrome is given by International Headache Society, which includes: Unilateral headache; MRI or biopsy demonstrating granulomatous inflammation of cavernous sinus, superior orbital fissure or orbit; ipsilateral nerve palsy involving one or more of 3rd, 4th and/or 6th cranial nerves; no alternate diagnosis based on the symptoms; specific history of ipsilateral headache localized to the ipsilateral brow and eye and it should occur 2 week before the oculomotor palsy or along with it. Our patient met all the criteria mentioned above. Ruling out other causes of headache and ophthalmoplegia is important in making the diagnosis. A differential diagnosis includes cavernous sinus thrombosis, stroke, vasculitis, myasthenia gravis, Miller Fisher variant of GBS, multiple sclerosis and idiopathic intracranial hypertension. Currently, inadequate data is available to determine the best route and duration of treatment with steroids. Our patient received oral steroid 100 mg for 3 days followed by slow steroid taper and had improvement in symptoms. Although a rare disorder, it is important to consider Tolosa-Hunt syndrome in the differential diagnosis of patients who presents with headaches and visual changes, especially after ruling out other common causes.

Made available in DSpace on 2017-07-21T18:15:21Z (GMT). No. of bitstreams: 1 Jasmine Cardozo Moreira.pdf: 5455170 bytes, checksum: 1b22241f34bc2ae9ce2bcfc91067156d (MD5) Previous issue date: 2015-11-24 / This project had the goal identify the perception of visitors of the Ecotouristic Municipal Park São Luis Tolosa ( PEMSLT ), located in the city of Rio Negro-PR during the year of 2014. Analyzed how the old Seraphic Seminary revitalization process that was active between the 1910s to 1970, transformed the place into an important integral protection conservation unit. It is now considered the main municipal park visitation and also disseminating awareness of preservation and conservation of native species, and a proposal for inter-relations between society and the environment as well as ecotourism. It also proposed public use strategies taking into account its principles of creation, trying to analyze the tourist nature of the protected area based on theoretical frameworks and perception of visitors by relating their habits and attitudes in PEMSLT. Also tried to verify how environmental education is carried out in the protected area, as an instructional tool to boost the participation of urban and tourism collective within the park. The methodology used was interviews to visitors from April to September 2014, with the development of direct and indirect questions, applied to visitors during their tour and visitation, and also behavioral analysis of visitors during their activities in the park. Most visitors realize that the most significant theme of PEMSLT's environmental focus, with emphasis on animal and plant species present. Highlight the preservation of the area in harmony with the architectural beauty of these buildings. However, visitors identify management needs in the direction of improvement of signs, constant presence of monitors trails enrichment of visitation and environmental awareness, greater coordination between the different spheres of the management team, improved fast-food infrastructure, responsibility and suggestions for the visitation trails. / Este trabalho teve por meta identificar a percepção dos visitantes do Parque Ecoturístico Municipal São Luís de Tolosa (PEMSLT), localizado no município de Rio Negro-PR, durante o ano de 2014. Analisou como o processo de revitalização do antigo Seminário Seráfico que esteve em atividade entre as décadas de 1910 a 1970, transformou o lugar em uma importante unidade de conservação de proteção integral. Atualmente é considerado o principal parque de visitação do município e também o disseminador da sensibilização de preservação e conservação de espécies nativas, e uma proposta de inter-relações entre sociedade e meio ambiente e também do ecoturismo. Propôs também estratégias de uso público levando em consideração seus princípios de criação, procurando analisar a natureza turística da unidade de conservação baseando-se em referenciais teóricos e na percepção dos visitantes, relacionando seus hábitos e atitudes no PEMSLT. Também procurou verificar como a educação ambiental é realizada na unidade de conservação, como ferramenta instrucional para dinamizar a participação do coletivo urbano e turístico dentro do parque. A metodologia utilizada foi a de entrevistas aos visitantes no período de abril a setembro de 2014, com a elaboração de perguntas diretas e indiretas, aplicadas aos visitantes, durante seu passeio e visitação, e também análise do comportamento dos visitantes durante suas atividades no parque. A maior parte dos visitantes percebeu que a temática mais expressiva do PEMSLT é o de enfoque ambiental, com destaque às espécies animais e vegetais presentes. Destacam a preservação da área em harmonia com a beleza arquitetônica das edificações presentes. Contudo, os visitantes identificaram necessidades de gestão no sentido de melhoramento das sinalizações, presença constante de monitores de trilhas para enriquecimento da visitação e da sensibilização ambiental, maior articulação entre as diferentes esferas da equipe de gestão, melhorias na infraestrutura de lanchonetes, de receptividade e sugestões para as trilhas de visitação.