Tolosa-Hunt Syndrome

A 25-year-old woman had headache and painful eye movements. Examination revealed left proptosis, ptosis, visual acuity OS (20/50), equally reactive pupils, a swollen optic disc oculus sinister-left eye (OS), and a normal optic disc oculus dexter-right eye (OD). Sensation was decreased on the left forehead. Magnetic resonance imaging revealed a diffusely enhancing retro-orbital mass extending to the superior orbital fissure and cavernous sinus (Figure 1). Steroids resulted in improvement but symptoms recurred after they were discontinued. Out of concern for malignancy a biopsy was done, showing dense fibrosis with calcified fragments (Figure 2)