Tohoku J. Exp. Med., 2013 Jan, 229(1)

Utility of Thallium-201 Scintigraphy in Tolosa-Hunt Syndrome

YOSUKE KAKISAKA,¹ TOMOKO KOBAYASHI,¹ MITSUGU UEMATSU,¹ YURIKA NUMATA,¹ MIEKO HIROSE,¹ NAOMI HINO-FUKUYO,¹ SHIGERU TSUCHIYA,¹ HIROSHI DOI,² HIROSHI FUKUDA³ and SHIGEO KURE¹

¹Department of Pediatrics, Tohoku University School of Medicine, Sendai, Miyagi, Japan
²Department of Ophthalmology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
³Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan

Tolosa-Hunt syndrome (THS) is a rare disorder, especially in the pediatric population, characterized by unilateral painful ophthalmoplegia with a relapsing-remitting course. Because the diagnosis of THS is based on the exclusion of other causes of painful ophthalmoplegia, attention should be paid to possible alternative diagnoses. Thallium-201 chloride (²⁰¹Tl) scintigraphy has been used to evaluate tissue histology in clinical oncology with a marker, the retention index (RI). A higher value indicates histological malignancy. Although its utility in pediatric THS has not been discussed, we suggest that ²⁰¹Tl scintigraphy may be informative as a marker in the diagnosis. We present an 11-year-old boy with THS who was evaluated with ²⁰¹Tl scintigraphy before treatment with corticosteroids, when he had headache, photophobia, and diplopia. The RI of ²⁰¹Tl indicated that the lesion would be benign. Although his clinical symptoms did not fulfill the THS criteria completely, his eye symptoms disappeared 2 weeks after corticosteroid treatment, which was not within the 72h as in the diagnostic criteria of THS. He has been symptom-free for more than 2years with only an initial 4-week corticosteroid therapy. This report not only shows the potential of ²⁰¹Tl scintigraphy to contribute to the correct diagnosis of pediatric THS but also suggests the possibility that the diagnosis of THS could be supported uniquely even in a pediatric THS-suspicious patient who did not fulfill the current THS criteria completely. In conclusion, we suggest that ²⁰¹Tl scintigraphy may be useful for making the diagnosis of THS, especially in pediatric patients.

keywords —— gallium-67 scintigraphy; International Classification of Headache Disorder; retention index; thallium-201 scintigraphy; Tolosa-Hunt syndrome

© 2013 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2013, 229, 83-86

Correspondence: Tomoko Kobayashi, M.D., Department of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

e-mail: fukuikobayashi@yahoo.co.jp