Tolosa Hunt Syndrome: A Challenging Diagnosis from Otorhinolaryngologist Perspective—A Case Report

Tolosa Hunt syndrome is a rare disorder characterized by idiopathic chronic granulomatous lesion involving cavernous sinus. The presenting symptoms are severe frontal headache, periorbital pain, ptosis, and diplopia. Usually, patients with headache and ptosis primarily visit neurologists or ophthalmologists. Only when imaging reveals any intracranial lesion involving paranasal sinuses, these patients get referred to otorhinolaryngologists. We would like to describe here the challenges we faced as otorhinolaryngologist, in diagnosis and management of a case of painful ophthalmoplegia as Tolosa Hunt Syndrome. A 55-year-old male presented to us with complaints of left frontal headache, periorbital pain, diplopia, and ptosis of left eye. Imaging and endoscopic biopsy revealed granulomatous lesion involving cavernous sinus with no evidence of fungal aetiology. Patient responded well to systemic steroid therapy with complete resolution of symptoms and no remission till two years of follow up. Tolosa Hunt Syndrome remains a diagnosis of exclusion. Trans-nasal endoscopic biopsy in selected cases may be contributory to the diagnosis. It responds well to systemic steroid therapy. Although chances of relapse are there yet prognosis is excellent.