Lymphoma of the orbit masquerading as Tolosa-Hunt syndrome Neuro-ophthalmology

Tarek A. Shazly, Ellen B. Mitchell, Gabrielle R. Bonhomme, Joel S. Schuman

Research output: Contribution to journalArticlepeer-review


Background: Tolosa-Hunt syndrome is a rare clinical syndrome characterized by painful ophthalmoplegia and ipsilateral cranial neuropathies. It is caused by an inflammatory process of unknown etiology. Case presentation: We present a case of a 77-year-old white man with history of Waldenstrom's macroglobulinemia transforming to large B-cell lymphoma who presented to a community physician complaining of 4 months of isolated right retro-orbital pain and later with diplopia, ptosis, 6th nerve and pupil-sparing partial 3rd nerve palsies as well as progressive neurological findings. His clinical course was complicated by debilitating neurological symptoms and multiple hospitalizations leading to a delay in diagnosis caused by incomplete initial workup. Conclusion: This case is a reminder that lymphoproliferative disorders often mimic other neurologic disorders and that Tolosa-Hunt is a rare diagnosis that must be considered a diagnosis of exclusion.

Original languageEnglish (US)
Article number51
JournalBMC Ophthalmology
Issue number1
StatePublished - May 15 2015


  • Cavernous sinus
  • Lymphoma
  • MRI
  • Neuro-imaging
  • Tolosa-Hunt

ASJC Scopus subject areas

  • Ophthalmology


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