NOSOLOGICAL ENTITIES?: The Tolosa-Hunt syndrome

Defining the syndrome The syndrome of painful ophthalmoplegia consists of periorbital or hemicranial pain, combined with ipsilateral ocular motor nerve palsies, oculosympathetic paralysis, and sen-sory loss in the distribution of the ophthalmic and occasionally the maxillary division of the trigeminal nerve. Various combinations of these cranial nerve palsies may occur, localising the pathological process to the region of the cavernous sinus/superior orbital fissure. The constellation of findings described may be due to four major causes: trauma, neoplasm, aneurysm, and inflammation. Comprehensive patient evaluation is essential in establishing