Neuro: Tolosa-Hunt syndrome: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Neuro: Tolosa-Hunt syndrome

Sample item

A patient has severe periorbital pain with painful ophthalmoplegia, and MRI shows enhancing soft tissue in the cavernous sinus. Symptoms resolve within 72 hours of starting steroids. This is:

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Tolosa-Hunt syndrome

Tolosa-Hunt syndrome is idiopathic granulomatous inflammation of the cavernous sinus or superior orbital fissure with painful ophthalmoplegia and a dramatic steroid response. It is a diagnosis of exclusion. Pituitary apoplexy has sudden headache with visual loss.

Option by option

  • A. Orbital pseudotumour with proptosis only

    Orbital pseudotumour usually has proptosis and orbital signs.

  • B. Tolosa-Hunt syndrome (correct)

    Correct. Painful ophthalmoplegia that responds to steroids is Tolosa-Hunt.

  • C. Idiopathic intracranial hypertension

    IIH has papilloedema.

  • D. Pituitary apoplexy

    Pituitary apoplexy presents with sudden headache and visual field loss.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is B, Tolosa-Hunt syndrome. Tolosa-Hunt syndrome is idiopathic granulomatous inflammation of the cavernous sinus or superior orbital fissure with painful ophthalmoplegia and a dramatic steroid response.

Why is "Orbital pseudotumour with proptosis only" not the answer?

Orbital pseudotumour usually has proptosis and orbital signs.

Why is "Idiopathic intracranial hypertension" not the answer?

IIH has papilloedema.

Why is "Pituitary apoplexy" not the answer?

Pituitary apoplexy presents with sudden headache and visual field loss.

What concept does this question test?

It tests Neuro: Tolosa-Hunt syndrome in Ophthalmology. It is a diagnosis of exclusion. Pituitary apoplexy has sudden headache with visual loss.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuro: Tolosa-Hunt syndrome?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.