Anatomy of the orbital apex and cavernous sinus
on high resolution magnetic resonance images.
Tolosa-Hunt syndrome (THS) is a painful, usually unilateral ophthalmoparesis or ophthalmoplegia caused by nonspecific inflammation (granulomatous or nongranulomatous) of the cavernous sinus
or superior orbital fissure.
Because dynamic MRI can show the space and soft tissues in cavernous sinus
better, it should be used in cases with an initial diagnosis of THS (8,9).
1,10) The three major presenting syndromes of CVT are isolated intracranial hypertension syndrome, focal cerebral syndrome (including cavernous sinus
syndrome) and encephalopathy.
Potential complications of these infections consist of orbital infections6, cerebral abscess7 and cavernous sinus
The first patient had a cavernous sinus
meningioma that was touching his optical pathways, which required dividing his treatment into five lower-dose sessions throughout the week.
Cerebral venous thrombosis with involvement of the cavernous sinus
Involvement of the cavernous sinus
is observed in 20% of macroadenomas and is usually unilateral (9).
sup] Othello syndrome secondary to right orbitofrontal lobe excision and right orbitofrontal lobe cavernous sinus
hemorrhage has been reported.
THS is a diagnosis of exclusion and it must be carefully differentiated from more malignant causes of cavernous sinus
involvement and painful ophthalmoplegia.
One patient with cavernous sinus
thrombosis and otitic hydrocephalus experienced a persistent right visual-field deficit.
Dr T N Janakiraman, a skull base surgeon trained in the US, explained that Bakhtiyar Khan,30, had a tumour in the cavernous sinus
, a large collection of thin-walled veins.
Sometimes, a damage to the cavernous sinus
can result in a blood clot that travels to the brain," the specialist added.
Brain magnetic resonance imaging showed abnormal enhancement involving the right cavernous sinus
extending along the tracks of the right fifth, seventh, and eighth cranial nerves (Figure 1).
1) Intracranial complications involve meningitis, brain abscess, and cerebral empyemas, whereas ocular complications comprise preseptal or orbital cellulitis, subperiosteal abscess, and cavernous sinus