Fact-sheet: Tolosa Hunt Syndrom
Updated on 12/08/2023 at 10:46 AM
Note : 10/10
( 1
note
)
View all RADEOS cases associated with this fact-sheet
Definition
Painful ophthalmoplegia syndrome, resulting from inflammation of the cavernous sinus and orbital apex.
Diagnostic criteria:
- unilateral orbital pain occurring in episodes and persisting for at least 8 weeks if untreated,
- palsy of one or more oculomotor nerves,
- resolution of pain within 72 hours of corticosteroid therapy initiation,
- and exclusion of other causes by neuroimaging (MRI).
Clinical features
- episodes of orbital and periorbital pain
- palsy of one or more ipsilateral oculomotor nerves
- ptosis
- blurred vision
CT
Enlargement of the cavernous sinus +/- contrast enhancement
Secondary criteria:
- internal carotid artery stenosis
- extension to the superior orbital fissure, orbital apex, and temporal fossa
MRI
Reference examination, which may show:
- Enlargement of the cavernous sinus
- Abnormal tissue in the cavernous sinus, isointense on T1, iso- to hyperintense on T2
- Contrast enhancement after injection during the active phase, decreasing after treatment
- Possible extension to the orbital apex, superior orbital fissure, and subtemporal fossa
Differential diagnosis
MRI findings are nonspecific and may also correspond to:
- Lymphoma
- Meningioma
- Sarcoidosis
- Wegener granulomatosis
- Pituitary tumor
- Cavernous sinus thrombosis
- Tuberculous meningitis