A rare case of unilateral total ophthalmoplegia- Tolosa hunt syndrome

• Author Details:   
• Shadakshari S Math
• Gayatri R Gondhali ^*
• Rahul K

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Tolosa hunt syndrome (THS) is a rare condition characterised by reversible painful ophthalmoplegia, episodic unilateral periorbital headache & paralysis of the 3rd, 4th &/or 6th cranial nerves which shows prompt response to steroids but can relapse & remit. Our patient is 23 years old female who presented with left eye painful total ophthalmoplegia with ipsilateral periorbital headache along with left eye ptosis & mild proptosis. Her all-routine investigations were within normal limits. MRI findings showed abnormality in left orbital apex and anterior aspect of cavernous sinus. After ruling out all differentials, the diagnosis of exclusion-Tolosa Hunt Syndrome was suspected. Patient when given trial of oral steroids showed drastic improvement. During follow-up visits, the drooping of the eyelid was decreased, and there was improvement in eye movements in all directions without pain or double vision. Early diagnosis not only decreases the severity & duration of disease but also reduces patient morbidity.

Keywords: Tolosa hunt syndrome, Painful total ophthalmoplegia, Ipsilateral headache, Cavernous sinus, Diagnosis of exclusion, Steroids.