“…THS is a diagnosis of exclusion and other causes of a painful ophthalmoplegia such as tumors, lymphoma, vasculitis, (pachy)meningitis, Ig4-related diseases, carotid artery dissection, sarcoidosis, Eales disease, cryopyrinassociated periodic fever syndrome and diabetes mellitus induced mononeuritis have been described in the literature. [1][2][3][4] Thus, all patients with suspected THS should have a broad evaluation including contrast-enhanced MRI. However, the introduction of the mandatory positive MRI finding as a diagnostic criteria is disputed since case series indicate that 20-50% of all THS have a negative MRI, and it has been suggested that granulomatous inflammation may be present even in the absence of a positive MRI.…”