IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Tolosa-Hunt syndrome

Case contributed by Dalia Ibrahim
Diagnosis almost certain

Presentation

Left painful ophthalmoplegia.

Patient Data

Age: 40 years
Gender: Male
mri

Intense homogeneously enhancing soft tissue mass lesion is seen at the left anterior cavernous sinus, orbital apex, and superior orbital fissure.

4 months post steroid therapy

mri

Significant size regression with near total resolution regrading the previously noted the left anterior cavernous sinus, orbital apex soft tissue mass.

4 months post steroid therapy

Annotated image

Significant size regression with near total resolution regrading the previously noted left cavernous sinus & orbital apex soft tissue mass.

Case Discussion

The second MRI exam is performed 4 months after steroid treatment, which revealed significant size regression.

The diagnosis in this case is presumptive (by MRI radiological features only), no biopsy was taken.

Tolosa hunt syndrome is a non-specific inflammation of the cavernous sinus and superior orbital fissure.

The  histopathological features of the disease is similar to those of idiopathic orbital pseudotumor; 

Clinical presentation (secondary to cavernous sinus inflammation)

  • Recurrent retro-orbital pain,
  • Palsy of the third, fourth or sixth cranial nerves as well as the first and second divisions of the trigeminal nerve.

Differential diagnosis includes other pathological processes presenting with similar clinical features like Meningioma, Sarcoidosis, Pituitary tumors, tuberculous meningitis, Lymphoma.

The disease is characterized by immediate dramatic response to steroid therapy.

The case is courtesy of Dr Mohamed Fouad, Mohamed Ibrahim & Bahaa Al Din Mahmoud.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.