With what does this disease have to be differentiated? The causes of the development of similar symptoms are a huge number: tumors of the middle cranial fossa, pterygoid pituitary, parasellar tumors, retrobulbar volumetric processes, cavernous sinus tumors, cavernous sinus thrombosis, carotid aneurysm, periostitis, osteomyelitis, leukemia in the upper globular region.
Do not forget about such diseases as myasthenia gravis, diabetes, thyroid pathology, temporal arteritis, meningitis, multiple sclerosis, migraine with aura. All of the above conditions can lead to ophthalmoplegia and impairment of the functions of the cranial nerves. That is why a patient with syndromes of movement of the eyeball and pain in one half of the face requires close attention. The research should be comprehensive and multifaceted. Consultation of the oculist for examination of fields and visual acuity, eye day is necessary. The neurologist should carefully collect the anamnesis, conduct a full clinical examination.
Of the additional methods of research should be noted neurovisualization methods (CT and MRI of the brain and Turkish saddle), angiography, echography of orbits.
According to modern criteria for diagnosing, Tolosa-Hunt syndrome can be set only in one case: when a magnetic resonance imaging (MRI) of the brain revealed granulomatous inflammation of the outer wall of the cavernous sinus. Under ideal conditions, a biopsy should be performed for diagnosis. Recent studies have shown that half of patients with confirmed diagnosis of the Tholos-Hunt syndrome present changes in the venous bed of the orbital region. If the granuloma is not detected during MRI, it is more appropriate to diagnose “upper globular fissure syndrome” and guide the patient under dynamic observation. There are also clinical diagnostic criteria that include such manifestations and conditions:
“Burning” or “tearing” pain of a permanent nature behind the eye socket or in the orbital temporal-frontal region;
impaired mobility of the eyeball, which occurred immediately or within 14 days after the onset of pain syndrome;
the defeat of other nerves that pass through the upper orbital gap (III, IV, VI cranial nerves, I branch of the trigeminal nerve, vegetative fibers);
symptoms intensify for several days, even weeks;
characterized by the presence of spontaneous remissions, often without residual effects;
the disease can return in a few months or years;
with a thorough examination, they do not find other reasons capable of causing this condition;
regress symptomatology within 72 hours after the onset of immunosuppressive therapy.