Overview
What is Tolosa-Hunt syndrome (THS)?
What is the pathophysiology of Tolosa-Hunt syndrome (THS)?
What is the prevalence of Tolosa-Hunt syndrome (THS)?
What is the morbidity associated with Tolosa-Hunt syndrome (THS)?
Presentation
Which clinical history findings are characteristic of Tolosa-Hunt syndrome (THS)?
Which physical findings are characteristic of Tolosa-Hunt syndrome (THS)?
What causes Tolosa-Hunt syndrome (THS)?
DDX
What are the differential diagnoses for Tolosa-Hunt Syndrome?
Workup
What is the role of lab tests in the workup of Tolosa-Hunt syndrome (THS)?
What is the role of imaging studies in the workup of Tolosa-Hunt syndrome (THS)?
What is the role of biopsy in the workup of Tolosa-Hunt syndrome (THS)?
Which histologic findings are characteristic of Tolosa-Hunt syndrome (THS)?
Treatment
How is Tolosa-Hunt syndrome (THS) treated?
What is the role of surgery in the treatment of Tolosa-Hunt syndrome (THS)?
Which specialist consultations are beneficial to patients with Tolosa-Hunt syndrome (THS)?
Medications
What is the role of steroids in the treatment of Tolosa-Hunt syndrome (THS)?
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MRI of a 40-year-old man with severe periorbital pain ocular sinister (OS; ie, left eye), complete oculomotor nerve palsy OS, and partial abducens nerve palsy OS. Axial imaging without (left) and with (right) enhancement demonstrates nonspecific fullness involving the left cavernous sinus, consistent with Tolosa-Hunt syndrome within the context of the history. Treatment with steroids produced complete resolution of symptoms. Image courtesy of Eric Eggenberger, DO.
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Coronal T1-weighted MRI with (below) and without (above) enhancement demonstrates left cavernous sinus fullness consistent with Tolosa-Hunt syndrome (THS). The imaging features are nonspecific and must be placed into the context of the history, examination, and clinical course to avoid misdiagnosis of infiltrating, infectious, or neoplastic cavernous sinus processes. Image courtesy of Eric Eggenberger, DO.