Computerised axial tomography andmagnetic resonancescanning intheTolosa-Hunt syndrome

SUMMARY A50-year-old Asian malepresented with a left sixth nerve palsy, left temporalpain,and rapidly deteriorating visual acuity in the left eye. Ahigh resolution CT scan and magnetic resonancescan showed a left retro-orbital enhancinglesion extendingfromthe lateral marginofthe cavernous sinus on to the greater wingofthe sphenoidandinto the left orbit. Arteriography was normal. Onhigh dose steroid therapy there was total resolution ofthe lesion. Thevalue ofimagingtechniquesin this conditionis discussed. The Tolosa-Hunt syndrome is a rare but wellrecognised cause of painful ophthalmoplegia' characterized by a granulomatous deposit in theregion of the anterior cavernous sinus2 which isusuallysteroidresponsive. Thepositionofthislesionmakes histological confirmation difficult and dangerous, andasthedifferential diagnosis includesinflammatory vascular and neoplastic lesions3accurate imaging techniques are invaluable. CT scanningis ofvalueinthediagnosisofthiscondition,but the appearances are not specific. This paperincludes magnetic resonance scans, which have notpreviouslybeenreportedin thiscondition.CasereportAnAsianmaleaged50presentedwithafour-month