Diagnosis:

• Painful opthalmoplegia over days to weeks, usually >40 y.o., causes cavernous sinus syndrome (dysfunction of cranial nerves III, IV, and VI, and the superior divisions of cranial nerve V)
• Must exclude other causes: trauma, inflammatory, infective, vascular, neoplastic
• ESR: high i supportive
• MRI

Findings on Investigations:

MRI:

• T1 isointense,
• T2 hyperintense,
• T1+contrast= enhancement

CT:

• Enlarged cavernous sinus
• May enhance with contrast

Investigations to consider:

MRI brain with and without contrast
ESR, CRP, ANA, c-ANCA, p-ANCA,
As per superior orbital fissure syndrome

Treatment:

Corticosteroids: prednisone 100mg/day & slow taper

Related articles:

• Approach to diplopia,
• Oculmotor nerve CN III palsy, trochlear nerve CN IV palsy, abducens nerve CN VI palsy,