Tolosa-Hunt Syndrome (THS) can be a challenging diagnosis and requires exclusion of other conditions.



(1) one or more episodes of unilateral orbital pain

(2) the episode may last for weeks if untreated

(3) one or both of the following

(3a) paresis of one or more cranial nerves (third, fourth, sixth)

(3b) granulomatous inflammation on biopsy or MRI (cavernous sinus, superior orbital fissure, orbit)

(4) paresis coincides with onset of pain or occurs within 2 weeks after onset

(5) pain and paresis quickly resolve (within 72 hours) with adequate doses of corticosteroids

(6) other causes of painful ophthalmopleiga have been excluded after a complete examination


Additional findings:

(1) Episodes may relapse and remit.

(2) Careful followup is important as an underlying cause may be found later.

(3) Other cranial nerves may be involved.

(4) Sympathetic innervation of the pupil may be involved occasionally.


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