BMC Neurol. 2025 Dec 2. doi: 10.1186/s12883-025-04555-0. Online ahead of print.
ABSTRACT
BACKGROUND: Diabetes mellitus (DM), a globally prevalent metabolic disease, affects the nervous system through multiple mechanisms, leading to cranial neuropathies. Tolosa-Hunt syndrome (THS) is a rare disorder that, when occurring in diabetic patients, may present with clinical manifestations that overlap with diabetic cranial neuropathy (DCN), increasing the risk of misdiagnosis and delaying corticosteroid treatment. This study aims to systematically analyze the clinical characteristics of THS in diabetic patients and explore optimal management strategies.
METHODS: This study conducted a retrospective analysis, integrating data from previously published cases and cases diagnosed at our center. Inclusion criteria were based on the diagnostic standards for THS outlined in the ICHD-3, while cases with other potential causes of headache and ophthalmoplegia were excluded. Data collected included baseline characteristics, clinical manifestations, treatment regimens, and therapeutic outcomes. Statistical analysis was performed using Fisher’s exact test, t-test, and Wilcoxon rank-sum test.
RESULTS: A total of 19 cases of diabetes-associated THS were included (11 males, 8 females), with males presenting at a significantly younger age than females (P = 0.041). All patients experienced severe headaches, 89.47% had ptosis, 94.73% exhibited ophthalmoplegia, and 15.79% presented with facial sensory disturbances. Eight patients were initially misdiagnosed with DCN and received neurotrophic therapy without improvement, but they responded rapidly to corticosteroid treatment. All patients showed significant symptom improvement within six days of corticosteroid administration. Methylprednisolone and dexamethasone demonstrated therapeutic effects comparable to prednisone, though symptom resolution was slightly delayed in the prednisone group.
CONCLUSION: The clinical features of diabetes-associated THS include severe headache, ptosis, and ophthalmoplegia, which can be easily confused with DCN. Corticosteroid therapy demonstrated high efficacy in this cohort. Clinicians should consider the possibility of THS in diabetic patients presenting with ptosis and ophthalmoplegia to avoid misdiagnosis and ensure timely corticosteroid treatment, thereby improving patient outcomes.
PMID:41331592 | DOI:10.1186/s12883-025-04555-0
