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Year : 2003  |  Volume : 51  |  Issue : 1  |  Page : 137

Tolosa-Hunt syndrome: MRI before and after treatment

Department of Child Health (Neurology), Sultan Qaboos University Hospital

Correspondence Address:
Department of Child Health (Neurology), Sultan Qaboos University Hospital

How to cite this article:
Koul R, Jain R. Tolosa-Hunt syndrome: MRI before and after treatment . Neurol India 2003;51:137

How to cite this URL:
Koul R, Jain R. Tolosa-Hunt syndrome: MRI before and after treatment . Neurol India [serial online] 2003 [cited 2023 Dec 8];51:137. Available from:

Contrast enhanced MRI of the brain revealed expansion of the right cavernous sinus due to an enhancing soft-tissue mass, engulfing and narrowing the intracavernous segment of the right internal carotid artery [Figure:1a] & [Figure:1b].
The child was started on oral Prednisolone 1 mg/kg/day. His headache resolved within 72 hours. The 6th nerve paralysis took 3 weeks to recover completely. Follow-up MRI after 6 weeks showed complete resolution of the abnormality [Figure - 2]. ESR at follow­up was 11 mm/ lst hour.
Tolosa-Hunt syndrome[1] is rare in children and is usually misdiagnosed as migraine which may not be so in adults.[2],[3] The condition is thought to be a non-specific inflammatory pseudotumor of the cavernous sinus. The most radiological differential diagnosis is from a cavernous sinus meningioma. The Tolosa-Hunt syndrome should be considered in severe and continuous headache with cranial nerve involvement (3rd, 5th and 6th) in children. MRI is the most important investigation and is diagnostic of the condition. 

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1.Kline LB, Hoyt AT. The Tolosa-Hunt Syndrome. J Neurol Neurosurg Psychiatry 2001;71:577-82.   Back to cited text no. 1    
2.del Toro M, Macaya A, Vazquez E, Riog M. Painful ophthalmoplegia with reversible carotid stenosis in a child. Pediatr Neurol 2001;24:317-9.  Back to cited text no. 2    
3.Bruyn GW, Ferrari M, deBeer FC. Migraine, Tolosa-Hunt syndrome and pleocytosis. Correlation or coincidence? Clin Neurol Neurosurg 1984;86:33-41.  Back to cited text no. 3    


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