Tolosa-Hunt Syndrome: A Rare Case of Painful Ophthalmoplegia in a Young Female

Tolosa-Hunt syndrome (THS) is a syndrome of painful episodic ophthalmoplegia due to nonspecific inflammation around the superior orbital fissure or the cavernous sinus, sometimes associated with paralysis of one or more of the cranial nerves III, IV, or VI. It is usually idiopathic but may have triggers such as tumors, aneurysms, or trauma. Since it is a diagnosis of exclusion, all other differentials such as cavernous sinus thrombosis, carotid-cavernous fistulae, giant cell arteritis, diabetic ophthalmoplegia, or ophthalmoplegic migraines should be ruled out. Diagnosis is mainly based on characteristic findings on clinical and radiological examination. The importance of diagnosing this condition lies in its management with steroids. This is one of the few neurological conditions that can completely resolve upon treatment. Here, we have a case of a young female who presented with painful ophthalmoplegia and ptosis of the left eye. She was diagnosed with THS on the basis of clinical and radiological features and showed complete resolution without any relapse with the administration of glucocorticoids. Therefore, early recognition of the condition and appropriate treatment lead to complete resolution of THS, as can be seen in our patient.