Tolosa-Hunt syndrome
Updates to Article Attributes
Tolosa Hunt syndrome (THS) is an idiopathic inflammatory condition that involves the cavernous sinus and orbital apex.
Clinical presentation
Clinically it refers to the presence of a painful ophthalmoplegia secondary to surrounding cavernous sinus inflammation. The Tolosa Hunt syndrome is essentially a clinical diagnosis of exclusion.
Pathology
The constant pain which characterises the disorder is due to infiltration of lymphocytes and plasma cells, along with thickening of dura mater within the cavernous sinus.
Radiographic features
CT
May show asymmetrical enlargement in the region of the cavernous sinus on the affected side +/- contrast enhanement 1.
The secondary criteria are internal carotid artery narrowing, extension towards the superior orbital fissure and orbital apex.
MRI
May show evidence of inflammatory changes in the region of the anterior cavernous sinus, superior orbital fissure +/- orbital apex. Signal characteristics are generally non specific 10 (clinical scenario essential to diagnosis) but may include
- T1: involved region is isointense 2 to hyperintense 8 compared with muscle
- T2: involved region is hyperintense
- C+ (Gd): may show contrast enhancment during active phase with resolution of enhancment following treatment 5,9
Related conditions
Treatment
The condition is often successfully amenable to steroid treatment.
Differential diagnosis
Consider other pathological processes presenting with similar clinical features such as meningioma, sarcoidosis, pituitary tumours, tuberculous meningitis, lymphoma.
History and etymology
It was initially described by Eduardo Tolosa, a Spanish neurosurgeon, in 1954 3 and then by the American neurologist and neurosurgeon William Edward Hunt et.al, in 1961 4.
-<p><strong>Tolosa Hunt syndrome</strong> <strong>(THS)</strong> is an idiopathic inflammatory condition that involves the cavernous sinus and orbital apex.</p><p> </p><h4>Clinical presentation</h4><p>Clinically it refers to the presence of a painful ophthalmoplegia secondary to surrounding <a href="/articles/cavernous-sinus">cavernous sinus</a> inflammation. The Tolosa Hunt syndrome is essentially a clinical diagnosis of exclusion.</p><h4>Pathology</h4><p>The constant pain which characterises the disorder is due to infiltration of lymphocytes and plasma cells, along with thickening of dura mater within the cavernous sinus.</p><h4>Radiographic features</h4><h5>CT</h5><p>May show asymmetrical enlargement in the region of the cavernous sinus on the affected side +/- contrast enhanement <sup>1</sup>.</p><p>The secondary criteria are internal carotid artery narrowing, extension towards the superior orbital fissure and orbital apex.</p><h5>MRI</h5><p>May show evidence of inflammatory changes in the region of the anterior cavernous sinus, superior orbital fissure +/- orbital apex. Signal characteristics are generally non specific <sup>10</sup> (clinical scenario essential to diagnosis) but may include</p><ul>- +<p><strong>Tolosa Hunt syndrome</strong> <strong>(THS)</strong> is an idiopathic inflammatory condition that involves the cavernous sinus and orbital apex.</p><h4>Clinical presentation</h4><p>Clinically it refers to the presence of a painful ophthalmoplegia secondary to surrounding <a href="/articles/cavernous-sinus">cavernous sinus</a> inflammation. The Tolosa Hunt syndrome is essentially a clinical diagnosis of exclusion.</p><h4>Pathology</h4><p>The constant pain which characterises the disorder is due to infiltration of lymphocytes and plasma cells, along with thickening of dura mater within the cavernous sinus.</p><h4>Radiographic features</h4><h5>CT</h5><p>May show asymmetrical enlargement in the region of the cavernous sinus on the affected side +/- contrast enhanement <sup>1</sup>.</p><p>The secondary criteria are internal carotid artery narrowing, extension towards the superior orbital fissure and orbital apex.</p><h5>MRI</h5><p>May show evidence of inflammatory changes in the region of the anterior cavernous sinus, superior orbital fissure +/- orbital apex. Signal characteristics are generally non specific <sup>10</sup> (clinical scenario essential to diagnosis) but may include</p><ul>
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