| Diagnostic approach for excluding Tolosa hunt syndrome mimics | ||
| APPROACH | INQUIRE/LOOK FOR/PERFORM | POSSIBLE MIMICS TO BE EXCLUDED |
| HISTORY TAKING | Onset (Acute, Subactute) | Pituitary Adenoma [26] , Orbital apex syndrome [2] [28] [29] , IgG4-related disease [30] |
| Associated Symptoms | Acute Orbital Myositis [31] , Cryopyrin-associated periodic fever syndrome [36] [37] , Extranodal NK/T-cell lymphoma [38] , Garcin syndrome [41] | |
| Localization | Trochleodynia [33] | |
| Progression | Carotid-cavernous fistula | |
| Past drug history | Orbital Aspergillosis [44] , THS in Pregnancy [46] | |
| Past medical history | Burkitt lymphoma metastasis [28] [45] | |
| PHYSICAL EXAMINTION | Diminished tendon reflex + extra-ocular movement | Miller Fisher Syndrome [53] |
| Visual acuity diminish, loss of nasal vision bilaterally | Clival chordoma [19] [56] | |
| Fluorescein angiography | Eales’ disease [57] | |
| Slit-lamp examination | Sclerokeratitis, Takayasu’s arteritis [58] | |
| LAB AND IMAGING | Voltage-gated calcium channel antibody | Lambert Eaton myasthenic syndrome |
| Serum creatinine kinase (CK) and lactate dehydrogenase (LDH) | Orbital myositis | |
| Acetylcholinesterase receptor antibody and repititive nerve stimulation | Myasthenia Gravis [43] | |
| Antibodies against GQ1b and GT1a | Miller Fisher Syndrome [53] | |
| Biopsy | Confirmation criteria [1] [17] [21] [28] [54] | |
| MRI | Confirmation criteria [1] [28] | |