We describe herein a patient who presented with painful ophthalmoplegia and was ultimately diagnosed via magnetic imaging resonance studies and successfully treated for Tolosa-Hunt syndrome. Tolosa-Hunt syndrome is a rare, reversible and painful ophthalmoplegia characterized by recurrent unilateral orbital pain, ipsilateral oculomotor paralysis and prompt response to steroids. Specific criteria for its diagnosis exist and are discussed herein. Individuals affected may display signs of select cranial nerve palsies, ptosis, facial numbness, diplopia, midrosis, and proptosis. Appropriate recognition of the disease can allow for immediate intervention and thus decrease the length and severity of symptoms especially as symptoms may not spontaneously resolve without treatment which leads to unnecessary suffering through pain, anxiety, and decreased vision. We describe the case presentation and keys for diagnosis emergency medicine that physicians should know for this potentially devastating condition.

This study was conducted to determine whether facial photographs obtained simultaneously with radiographs improve radiologists' detection rate of wrong-patient errors, when they are explicitly asked to include the photographs in their evaluation. Radiograph-photograph combinations were obtained from 28 patients at the time of portable chest radiography imaging. From these, pairs of radiographs were generated. Each unique pair consisted of one new and one old (comparison) radiograph. Twelve pairs of mismatched radiographs (i.e., pairs containing radiographs of different patients) were also generated. In phase 1 of the study, 5 blinded radiologist observers were asked to interpret 20 pairs of radiographs without the photographs. In phase 2, each radiologist interpreted another 20 pairs of radiographs with the photographs. Radiologist observers were not instructed about the purpose of the photographs but were asked to include the photographs in their review. The detection rate of mismatched errors was recorded along with the interpretation time for each session for each observer. The two-tailed Fisher exact test was used to evaluate differences in mismatch detection rates between the two phases. A p value of <0.05 was considered significant. The error detection rates without (0/20=0 %) and with (17/18= 94.4 %) photographs were different (p=0.0001). The average interpretation times for the set of 20 radiographs were 26.45 (SD 8.69) and 20.55 (SD 3.40)min, for phase 1 and phase 2, respectively (two-tailed Student t test, p=0.1911). When radiologists include simultaneously obtained photographs in their review of portable chest radiographs, there is a significant improvement in the detection of labeling errors. No statistically significant difference in interpretation time was observed. This may lead to improved patient safety without affecting radiologists' throughput.