Paediatric Tolosa-Hunt syndrome: the need for treatment guidelines and renewed criteria

Abstract

SIR–Tolosa-Hunt syndrome (THS) is a rare disorder, especially in the paediatric population, characterized by unilateral painful ophthalmoplegia of, typically, a relapsing-remitting course and a substantial response to corticosteroids. The symptoms of THS are not specific and clinical criteria themselves do not guarantee a firm diagnosis. Neuroimaging or biopsy confirming granulomatous inflammation is essential to ad iagnosis of THS. Although diagnostic criteria were established by the International Headache Society in 1988, then revised in 2004 (Table I), 1 THS remains a diagnosis of exclusion of other causes of painful ophthalmoplegia, (e.g. neoplasms, aneurysms, cranial neuropathy [diabetes mellitus], opthalmoplegic migraine, intracranial vasculitis, pseudotumor of the orbit, basal meningitis, or cavernous sinus thrombosis). 2