Context: Tolosa-Hunt Syndrome (STH) is a rare condition with unknown etiology, it affects both genders equally. It is manifested by inflammation of the cavernous sinus and involvement of some cranial nerves pairs. Case report: MSR, 39 years, male, diver in the mining zone, history of recurrent otitis with acute pain and gradual hearing loss that progressed. He was admitted to the General Hospital of Palmas with symptoms of retrorbital headache. After physical exams it was found an ophthalmoplegia with right amaurosis and ipsilateral pain. The neurological examination showed a right eye with loss of photomotor reflex and presence of consensual reflex and eyelid ptosis. After 38 days in hospital, a probable septic thrombosis of the cavernous sinus was found, antibiotic and corticosteroids therapy was initiated. The patient also reports significant improvement in headache and partially in vision, he is currently hospitalized with clinical care and antibiotic therapy, awaiting results of the image examination report. Conclusions: Painful ophthalmoplegia in most cases is not diagnosed as STH. The differential diagnosis for this pathology is most often through brain magnetic ressonance and the ICHD-3 beta diagnostic criteria, STH should be suspected, but it is still necessary to close the diagnosis by exclusion, due to the lack of a specific diagnosis.

Context: The Artery of Percheron (AOP) is an uncommon anatomic vascular variation derivated from posterior cerebral artery segment P1, wich branchs to irrigate bilaterally the thalamus in it is paramedian portion. Amidst vascular cerebral events of the ischemic type, thalamic infarction occour in 11% of the cases. The typical clinical presentation is constituted by the triad: cogniyivebehavior comitente, oculomotors and consience disturbs. Case report: J.F.M.L, 51 years old, male, was found unconscious in his residence by SAMU and then interned in Stroke Room of HGP in 02/06/2020 with a lowered level of consciousness (Glasgow 8). The tests demonstrated a bilateral thalamic infarct due to Artery of Percheron Ischemia. In 02/09/2020 it evolved into a Glasgow 9 being extubated. The CT after 3 days demonstrated absence of bleeding and prophylatically initiated simvastatin, clexane, physiotherapy and phonoaudiology. In 02/15/2020, during physical exam, the pacient was lucid, presented behavior alterations, had left cervical dystonia and ataxia. The patient progressed well and was discharged the next day. Conclusions: The AOP, when occluded, results in bilateral paramedian thalamic and the rostral midbrain infarctions wich may cause diagnosis issues, mainly because of the vast specter of diferential diagnosis. In the presence of triad signals characteritic of bilateral thalamic infarction in CT, it must suspect the manifestation of such entity.