DR. LAGNAJEETA BANERJEE

DR. PRITI SINGH, DR.SUNIL VERMA, DR. VIDHYA VERMA

Abstract

Tolosa Hunt syndrome (THS) is described as episodic, unilateral orbital/periorbital pain with paralysis of multiple cranial nerves. 41-year-old female presented with complaint of left hemi cranial headache for 1 week with diminution of vision (PL positive) and drooping of left upper eyelid. Presenting visual acuity in right eye was 6/9. Examination showed left severe ptosis, left third, fourth and sixth cranial nerve palsy with relative afferent pupillary defect in the left eye. Fundus examination showed mild temporal disc pallor in left eye. Routine blood investigations were unremarkable. MRI orbit showed abnormal soft tissue enhancement at the left orbital apex and supraorbital fissure with inflammatory changes in the surrounding extraocular muscles. . Ptosis and extraocular movements improved with vision hand movement after 5days of intravenous steroid therapy. THS is a diagnosis of exclusion where clinical presentation, MRI findings and response to steroid are crucial pointers.