Clinical and Radiological Findings Suggesting Disorders Other Than Tolosa–Hunt Syndrome Among Ophthalmoplegic Patients: A Retrospective Analysis

Abstract

A diagnosis of THS based strictly on clinical presentations or imaging results is not completely reliable. Identification of atypical imaging features may have a useful role in discriminating SPOs and thus avoid erroneous diagnoses of THS. Future studies with larger sample sizes are warranted to evaluate their validity in general population.

Evaluation and Management of Tolosa–Hunt Syndrome in Children: A Clinical Update

“…In addition to cavernous contrast MRI enhancement, focal ICA narrowing can be seen in some cases (44% in this study) [2,10,44]. Rarely, these changes may only be detectable on angiography despite a normal MRI [44].…”

“…Pediatric THS occurs without sex predilection and patients generally report a "boring" or "stabbing" retro-orbital pain that is typically preceded by the ophthalmoplegia by several days, but it can also occur simultaneously with it or precede it in some cases. As with adults, the third cranial nerve is most frequently involved, followed by the sixth, fourth and fifth cranial nerves [2,5,7,10]. Symptoms are typically unilateral but bilateral presentations can also occur.…”

“…Painful ophthalmoplegia is a rare pathologic condition characterized by any combination of unilateral periorbital or hemicranial pain, ipsilateral oculomotor paralysis, and oculosympathetic dysfunction [1][2][3]. The differential diagnosis is extensive and includes neoplastic, infectious, vascular, and inflammatory causes [3][4][5][6].…”

“…However, other conditions such as lymphoma, sarcoidosis, and meningioma can have similar findings and the clinician must keep these in mind when interpreting MRI results [2,5,39,40]. Infrequently, the MRI can be normal in patients with THS [9,12,33,38,[41][42][43].…”

A case of headache, double vision and ptosis in emergency department: Tolosa-Hunt syndrome

“…The majority of cases reported as THS consisted of adults without sex discrimination. In addition, pain is usually unilateral, and double vision is mostly due to the influence on the 3rd cranial nerve 4, 6, 7, 8. Günaydın et al 9 .…”