Presentation
Left diplopia and painful ophthalmoplegia.
Patient Data
Intensely enhancing lesion in close relation to left cavernous sinus reaching up to orbital apex / superior orbital fissure, partially encasing cavernous segment of left ICA. It appears isointense on T1 and hyperintense on T2, DWI scans.
Asymmetry of cavernous sinuses is seen with prominence of left cavernous sinus.
Subtle edema is seen in extraocular muscles on left side.
Subtle hyperintensity seen within retroocular portion of left optic nerve.
Case Discussion
Above findings suggest the possibility of Tolosa-Hunt syndrome. Main differential diagnosis based on imaging findings would be pachymeningitis. However, clinical history, imaging findings, their location and extent suggest diagnosis of Tolosa-Hunt syndrome.