Tolosa-Hunt syndrome

Tolosa-Hunt syndrome (THS) is an idiopathic inflammatory condition that involves the cavernous sinus and orbital apex, and is essentially a clinical diagnosis of exclusion.

Clinically it refers to the presence of a painful ophthalmoplegia secondary to surrounding cavernous sinus inflammation. Tolosa-Hunt syndrome is essentially a clinical diagnosis of exclusion.

The constant pain that characterises the disorder is due to infiltration of lymphocytes and plasma cells, along with thickening of dura mater within the cavernous sinus.

CT

May show asymmetrical enlargement in the region of the cavernous sinus on the affected side +/- contrast enhancement 1.

The secondary criteria are internal carotid artery narrowing, extension towards the superior orbital fissure and orbital apex.

MRI

May show evidence of inflammatory changes in the region of the anterior cavernous sinus, superior orbital fissure +/- orbital apex. Signal characteristics are nonspecific 10 (clinical scenario essential to diagnosis) but may include:

  • T1: involved region is isointense 2 to hyperintense 8 compared with muscle 
  • T2: involved area is hyperintense
  • T1 C+ (Gd): may show contrast enhancement during active phase with resolution of enhancement following treatment 5,9

The condition is often successfully amenable to steroid treatment.

It was initially described by Eduardo Tolosa, a Spanish neurosurgeon, in 1954 3 and then by the American neurologist and neurosurgeon William Edward Hunt et al, in 1961 4.

Consider other pathological processes presenting with similar clinical features such as meningioma, sarcoidosis, pituitary tumours, tuberculous meningitis, lymphoma.

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Article Information

rID: 9206
Synonyms or Alternate Spellings:
  • Tolosa Hunt syndrome (THS)
  • Tolosa-Hunt syndrome

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