Tolosa-Hunt syndrome with enlargement of optic nerve shadow on CT

Two cases of Tolosa-Hunt syndrome (THS) accompanied by optic nerve shadow enlargement on CT were reported. They were a 36 year old man and a 46 year old woman, who had visual disturbance, palpebral edema, and exophthalmos on the affected side. Orbital venography revealed obstruction of the superior orbital vein at the third portion and CT showed optic nerve shadow enlargement on the affected side. When optic nerve shadow enlargement on CT disappeared after steroid therapy, visual acuity improved clinically. Therefore it is likely that optic nerve disturbance by orbital venous congestion was the cause of the visual disturbance. In previous reports, visual disturbance was reported in about 20% of patients with THS. However, there is no report of a patient with THS associated with optic nerve shadow enlargement on CT.