Tolosa-Hunt Syndrome: A Case Report

Tolosa-Hunt syndrome (THS) is a rare neurological condition characterized by ophthalmoplegia preceded by retroorbital pain or headache. It mainly involves cranial nerves III, IV, and VI. The majority of the time, the cause is unknown; it is believed that the cause is nonspecific granulomatous inflammation of the cavernous sinus and superior orbital fissure or rarely beyond. THS is an exclusionary diagnosis. It is diagnosed clinically according to the patient's symptoms, neuroimaging test results, and response to corticosteroid therapy. The mainstay of treatment is corticosteroid therapy. A 62-year-old man, a known case of hypertension (HTN) and type 2 diabetes mellitus (T2DM), presented with an acute history of right-sided headache and diplopia, associated with right eye pain and tearing. The patient was stable, with a Glasgow Coma Scale (GCS) score of 15/15. Neurological examination showed right eye ptosis, impairment of lateral and upward movement of the eye, and reduced sensation on the right V1 and V2. The left side of the face was positive for flat nasolabial folds. Later, the patient complained of decreased visual acuity. The diagnosis was confirmed with an orbital magnetic resonance imaging (MRI). The patient improved on prednisolone therapy. THS should be considered in patients presenting with painful ophthalmoplegia, as early diagnosis prevents unnecessary invasive procedures and ensures effective treatment, which can significantly reduce morbidity.