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The Tolosa-Hunt syndrome is recurrent painful ophthalmoplegia due to nonspecific cavernous sinus inflammation. The documented incidence is one to two cases per million and bilaterality is even rarer. Delay in diagnosis might lead to permanent cranial nerve damage. Our purpose in this study is to discuss clinical and radiological features of the disease. We reported two patients whom presented with external ophthalmoplegia. The preliminary clinical diagnosis was ophthalmoplegic migraine. The primary radiological evaluation including cranial CT, cerebral angiography, magnetic resonance venography were all in normal limits. Finally MR imaging was performed which demonstrated the disease in the cavernous sinus region. We believe this article will serve not only to radiologists but a broad group of specialists including neurologists, otolaryngologists, internal medicine physicians dealing with cases of external ophthalmoplegia.

The Radiological Evaluation of External Ophthalmoplegia: Tolosa-Hunt syndrome