Question

Patient with severe headache, bilateral periorbital edema, and CN III, IV, V, and VI deficits:

a) Migraine with aura
b) Subarachnoid hemorrhage
c) Idiopathic intracranial hypertension
d) Tolosa-Hunt syndrome

Answer 1

A patient presenting with severe headache, bilateral periorbital edema, and deficits in multiple cranial nerves likely has Tolosa-Hunt syndrome, characterized by painful ophthalmoplegia due to granulomatous inflammation.

Step-by-step explanation:

A patient with severe headache, bilateral periorbital edema, and deficits in cranial nerves (CN) III, IV, V, and VI is most likely suffering from Tolosa-Hunt syndrome. This condition is characterized by a painful ophthalmoplegia due to granulomatous inflammation in the cavernous sinus or superior orbital fissure. It can cause symptoms such as headache, periorbital edema, and double vision or diplopia resulting from a failure in conjugate gaze, affecting the movements of the eye, leading to defects in CN III, IV, and VI. Facial sensation affected by CN V can also be involved, adding to the complexity of differential diagnoses.

Other conditions like migraine with aura, subarachnoid hemorrhage, and idiopathic intracranial hypertension have overlapping symptoms such as headaches, but the combination of ophthalmoplegia and bilateral periorbital edema points more specifically to Tolosa-Hunt syndrome.