eISSN: 2720-5371
ISSN: 1230-2813
Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii
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vol. 33
Case report

Tolosa-Hunt syndrome: a review of diagnostic criteria based on a case series

Piotr R. Chądzyński
Katarzyna Stopińska
Izabela Domitrz

  1. Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Bielański Hospital, Poland
Adv Psychiatry Neurol 2024; 33 (1): 26–34
Online publish date: 2024/02/12
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Tolosa-Hunt syndrome (THS) is a rare cause of painful ophtalmoplegia with different clinical manifestations. It is des­cribed as a unilateral periorbital headache with concomitant dysfunction of at least one out of the IIIrd, IVth and VIth cranial nerves due to the granulomatous inflammation of periorbital structures, but no underlying cause has been established.

Case description
We present six patients referred to the Neurology Department due to a unilateral headache with ipsilateral paresis of at least one cranial nerve responsible for eye movements. The THS diagnostic criteria of the International Headache Disorders Classification (ICHD-3) were applied and analysed. Few patients had atypical clinical manifestations according to these criteria.

Diagnosing THS may prove very challenging. There is a lack of specific markers for the disorder, whereas diagnostic criteria leave a wide area for misdiagnosis. The diagnostic approach should be focused on the exclusion of other pathologies because typical steroid therapy may prove fatal in otherwise benign cases.


pain, case report, headache, Tolosa-Hunt syndrome, ophtalmoplegia

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