Probable Tolosa-Hunt syndrome with a normal MRI

Area of Science:

• Neurology
• Ophthalmology

Background:

• Reporting a rare case of Tolosa-Hunt syndrome (THS) in a 60-year-old woman with a history of end-stage renal disease and non-Hodgkin lymphoma.
• The patient presented with confusion, unilateral headache, painful ophthalmoplegia, and ptosis.

Observation:

• Tolosa-Hunt syndrome (THS) is a diagnosis of exclusion, requiring ruling out of other conditions.
• Magnetic resonance imaging (MRI) of the brain and orbit yielded negative results twice within a week.
• The patient exhibited symptoms including confusion, unilateral headache, painful ophthalmoplegia, and ptosis.

Findings:

• Corticosteroid treatment led to marked improvement in orbital pain and headache.
• Mild improvement was observed in cranial nerve palsy following corticosteroid therapy.
• This case adds to findings of THS despite a normal MRI, challenging diagnostic prerequisites.

Implications:

• Clinical diagnosis of THS can be supported by radiological findings, even if normal.
• The study suggests that MRI or biopsy may not be mandatory for THS diagnosis.
• Limitations in MRI utility for diagnosing THS in certain patients are acknowledged.