A patient presents with unilateral painful ophthalmoplegia. Imaging revealed an enlargement of cavernous sinus on the affected side. The likely diagnosis is:

Answer is C (Tolosa-Hunt Syndrome): Painful ophthalmoplepia with enlargement of ipsilateral cavernous sinus on imaging (CT/MRI) suggests a diagnosis of Tolosa-Hunt syndrome Orbital pseudo tumors, Gradenigo syndrome and cavernous sinus thrombosis may present with ophthalmoplegia, but enlargement of cavernous sinus is not a characteristic feature of these syndromes Tolosa-Hunt syndrome Tolosa-Hunt Syndrome consists of painful ophthalmoplegia caused by idiopathic inflammation of the cavernous sinus The idiopathic non-specific inflammation often results in a mass of granulation tissue around the cavernous sinus or superior orbital fissure leading to constant pain and asymmetrical enlargement of the cavernous sinus. The disorder is usually unilateral although bilateral cases have been repoed The symptoms show excellent response to steroid therapy and pain is usually relieved within 72 hours of initiation of steroid therapy