Possible Tolosa Hunt Syndrome

The Tolosa Hunt syndrome (THS) refers to the presence of a painful ophthalmoplegia secondary to surrounding cavernous sinus inflammation Tolosa Hunt syndrome is essentially a clinical diagnosis of exclusion.
MRI findings in THS can include:

1. Inflammation of the cavernous sinus, superior orbital fissure, or orbital apex.
2. Narrowing of the intracavernous internal carotid artery.

This case of 52 year old female reveals isointense lesion in the region of left cavernous sinus with enhancement on post gadolinium scans and smaller left ICA flow void, as the lesion was isointense on T2 weighted images and differential diagnosis of meningioma versus THS was suggested. Along with follow up scan after steroid to confirm the diagnosis.  MRI scans should be performed every 1-2 months to monitor improvement and maintenance of improvement on and then off treatment, until findings normalize.