Neuroimaging in a woman with left-sided steroid-responsive painful ophthalmoplegia from cavernous sinus syndrome caused by bacterial sphenoid sinusitis

(a) Contrast-enhanced coronal T1 MRI of the first headache attack (left-sided headache) on December 12, 2020. The left cavernous sinus was enlarged and widened. The abnormal tissue strongly enhanced after intravenous injection of the contrast material. (b) Contrast-enhanced coronal T1 MRI of the second headache attack (right-sided headache) on January 10, 2021. The increased soft tissue shadows were present in cavernous sinuses bilaterally and were more pronounced on the right. (c) Axial sinus CT on January 14, 2021, shows inflammation of the right sphenoid sinus cavity. (d) One month after surgical and antibiotic therapy, MRI showed that the signal shadow of the cavernous sinus was less than before, although inflammation was still observed on the right side. (e-f) Two months after treatment, MRI showed a normal cavernous sinus and sphenoid sinus.

(Source: He W, Zhu Y, Zhang Y, Dong L, Zhou Z, Zhou J. A case report on recurrent alternating Tolosa-Hunt syndrome due to bacterial sphenoid sinusitis: rediscussing the diagnostic terminology and classification. BMC Neurol. 2023;23[1]:25. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)