Tolosa—Hunt Syndrome: Critical Literature Review Based on IHS 2004 Criteria

Abstract

Dear Sir We carefully read the review article by La Mantia et al. (1); however, we believe that some facts regarding the Tolosa–Hunt syndrome (THS) diagnosis must be taken into account, based on the criteria of the International Classification of Headache Disorders, second edition (ICHD-II) (2).

In the first paragraph, the authors clearly show misunderstanding of the current diagnostic criteria for THS by claiming that the presence of granuloma by magnetic resonance imaging (MRI) or biopsy is essential for diagnosing THS. According to Criterion B (code 13.16: paresis of one or more of the third, fourth and/or sixth cranial nerves and/or demonstration of granuloma by MRI or biopsy) (2), one can conclude that THS diagnosis is possible even in the presence of normal MRI. Also, contrary to the authors' suggestion in the last paragraph of the Discussion, THS cases with normal MRI are addressed by ICHD-II (2).

We agree with La Mantia et al. that the clinical features suggesting THS are not specific for that syndrome, but are common to several conditions and that their presence alone does not guarantee the correct diagnosis. For this reason, we would like to point out that, in order to diagnose THS, it is necessary to rule out other causes of painful ophthalmoplegia through appropriate investigation, according to Criterion E (code 13.16, ICHD-II) (2).

F Dach and J Speciali, Department of Neurology, University of São Paulo, School of Medicine at Ribeirão Preto, Hospital of Clinics, Av. Bandeirantes, 3900 Canpus Universitário Ribeirão Preto São Paulo 14000-000, Brazil. E-mail fabioladach@yahoo.com.br

References

1 La Mantia

Curone

Rapaport

Bussone

. Tolosa–Hunt syndrome: critical literature review based on HIS 2004 criteria. Cephalalgia 2006; 26:772–81.

2 Headache Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edition. Cephalalgia 2004;24 (Suppl. 1):1–160.