Tolosa-Hunt syndrome revealed by MRI: A radiological perspective on painful ophthalmoplegia

Tolosa-Hunt syndrome (THS) is a rare and idiopathic granulomatous inflammation of the cavernous sinus and adjacent structures, classically presenting as painful ophthalmoplegia. We report a case of a 53-year-old woman who presented with right periorbital headache and an incomplete cavernous sinus syndrome affecting cranial nerves III, IV, V1, and V2. MRI demonstrated a strongly enhancing lesion in the right cavernous sinus without evidence of thrombosis or orbital invasion. The patient showed rapid clinical improvement following corticosteroid therapy. This case highlights the critical role of MRI in the diagnosis, exclusion of mimickers, and monitoring of treatment response in THS.