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Complete ophthalmoplegia diagnosed as Tolosa-Hunt syndrome on interval MRI
  1. Shane Bowman1 and
  2. Andrew Helming2
  1. 1School of Medicine, Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon, USA
  2. 2Department of Radiology, Oregon Health and Science University, Portland, Oregon, USA
  1. Correspondence to Dr Andrew Helming; helming{at}


Tolosa-Hunt syndrome is a rare cause of painful ophthalmoplegia, most commonly presenting with retro-orbital pain and eye motor nerve palsy, most often affecting a single eye. The condition is characterised by an idiopathic process causing granulomatous inflammation to the cavernous sinus affecting, one or multiple cranial nerves that pass therein. The mechanism underlying the inflammation is not well understood, but patients have been observed to respond to steroids during a flare. We present this as a unique case where a multidisciplinary team diagnosed Tolosa-Hunt syndrome despite non-specific MRI findings in the cavernous sinus 1 day following an initially normal MRI.

  • Neuroimaging
  • Headache (including migraines)
  • Cranial nerves
  • Neuroopthalmology

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  • Contributors SB and AH conception, organisation, drafting and revising.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.