title: Tolosa-Hunt syndrome masquerading as a carotid artery dissection.
abstract: OBJECTIVE
  To demonstrate the difficulties of diagnosing a patient with Tolosa-Hunt syndrome (THS) due to its complicated presentation and extensive diagnostic testing, and how to manage the treatment of a patient in an emergent setting.
  
  
  METHODS
  A female patient with THS affecting the left eye was examined using two magnetic resonance imaging (MRI) scans. The patient was treated with high-dose methylprednisolone (Solu-Medrol(®)) and prednisone. A follow-up MRI and magnetic resonance angiogram (MRA) was also performed 4 months later.
  
  
  RESULTS
  The second MRI scan disclosed a 5×9×10 mm lesion in the left superior orbital fissure/cavernous sinus. After administration of methylprednisolone and prednisone, the patient's pain completely resolved, and the left eye regained full duction and eyelid mobility. The MRI and MRA obtained after the treatment showed no abnormalities.
  
  
  CONCLUSIONS
  The rarity of THS makes it difficult to diagnose, especially when there is a question of accuracy and reproducibility of the testing performed. An ophthalmologic consultation in such cases is crucial.
authors.affiliation: Research Center, Martel Eye Medical Group, Rancho Cordova, CA, USA.
authors.forename: Elise J
authors.initials: EJ
authors.lastname: Taylor
authors.affiliation: Research Center, Martel Eye Medical Group, Rancho Cordova, CA, USA.
authors.forename: Ursula M
authors.initials: UM
authors.lastname: Anders
authors.affiliation: Research Center, Martel Eye Medical Group, Rancho Cordova, CA, USA ; Graduate Medical Education, California Northstate University College of Medicine, Elk Grove, CA, USA ; Department of Ophthalmology, Sutter Medical Health, Sacramento, CA, USA ; Department of Ophthalmology, Dignity Health, Carmichael, CA, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Martel
authors.affiliation: Research Center, Martel Eye Medical Group, Rancho Cordova, CA, USA ; Graduate Medical Education, California Northstate University College of Medicine, Elk Grove, CA, USA ; Department of Ophthalmology, Sutter Medical Health, Sacramento, CA, USA ; Department of Ophthalmology, Dignity Health, Carmichael, CA, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Martel
keywords: granulomatous lesion; idiopathic orbital inflammation; multiple cranial nerve palsies; painful ophthalmoplegia
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