Neurological and radiological studies in painful ophthalmoplegia: Tolosa-Hunt syndrome and orbital pseudotumour.

Twelve patients with idiopathic painful ophthalmoplegia were studied by CT, which was found to be normal in 6 patients, but with a high density area in the orbit in the others. This abnormal high density area was not found when CT was performed at a relatively early stage of the disease, but was seen when it was performed more than 1 month after the onset of symptoms. Orbital phlebography was performed in 6 of 12 patients; 3 with normal and 3 with abnormal CT findings. An occlusion of the superior ophthalmic vein was seen in 3 patients with abnormal CT, but not in 3 patients with normal CT. All 12 patients improved with administration of corticosteroids. The results suggest that the intraorbital abnormality revealed by CT may be due to an inflammatory process in the chronic stage and/or the oedematous and infiltrating processes in soft tissues which can be caused by the occlusion of the superior ophthalmic vein or cavernous sinus.