Painful ophthalmoplegia due to Tolosa-Hunt syndrome: a case report

Tolosa-Hunt syndrome (THS) is a rare clinical entity, characterized by sudden onset of painful ophthalmoplegia and prompt response to steroid therapy. Generally, it involves the third, fourth, and sixth cranial nerves due to presence of non-specific inflammation at the level of cavernous sinus or superior orbital fissure. In some cases, first or second division of trigeminal nerve may also be involved. Here we present a case report on THS, a rare cause of painful ophthalmoplegia. The patient presented with sudden onset, unilateral headache, drooping of left upper eyelid followed by diplopia. On examination, the patient had complete ophthalmoplegia, along with ophthalalmic division of trigeminal nerve was also involved. Magnetic resonance imaging (MRI) brain showed expansion of left cavernous sinus suggesting THS. Other differentials of THS were ruled out on the basis of careful history, examination, and investigations.