American Journal of Neuroradiology

Classic Case

Section Editors:
Anvita Pauranik, MD, University of British Columbia, Vancouver, British Columbia, Canada
Michael Travis Caton, MD, Mount Sinai South Nassau, New York
Simona Gaudino, MD, Università Cattolica del Sacro Cuore, Italy
Matthew S. Parsons, MD, Mallinckrodt Institute of Radiology, Missouri
Anat Yahav-Dovrat, MD, University of Toronto, Canada

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November 25, 2013

Tolosa-Hunt Syndrome

Figure Caption
Tolosa-Hunt syndrome (THS) is characterized by the clinical triad of unilateral painful ophthalmoplegia, cranial nerve palsies, and a dramatic response to systemic corticosteroids. The syndrome is assumed to be the result of an exaggerated immune response to a viral or bacterial infection. On MRI, abnormal soft tissue is seen in the cavernous sinus, which may encase and decrease the caliber of intracavernous part of the internal carotid artery (white arrow). The lateral dural reflection of involved cavernous sinus becomes convex (yellow arrow). This soft tissue enhances avidly after gadolinium administration and may extend to the superior orbital fissure, orbital apex, and Meckel’s cave (blue arrow). THS is a diagnosis of exclusion by classic MRI findings and typical clinical history.