American Board of Psychiatry and Neurology (ABPN) Practice Exam

The presentation of headaches, double vision (diplopia), and ptosis strongly suggests involvement of the cranial nerves, particularly those controlling eye movement and eyelid function. Tolosa-Hunt syndrome is characterized by unilateral ophthalmoplegia, which can result in double vision and drooping of the eyelid due to the inflammation of the cavernous sinus that affects the cranial nerves III (oculomotor nerve), IV (trochlear nerve), and VI (abducens nerve).

In Tolosa-Hunt syndrome, the inflammation is typically idiopathic, and it often responds rapidly to corticosteroid treatment. The acute onset of these symptoms, along with headache and the specific eye manifestations, aligns with this syndrome. The condition is diagnosed based on clinical presentation and the response to treatment, as imaging typically reveals a mass effect in the cavernous sinus area without other identifiable causes, such as tumors or vascular lesions.

Other conditions listed may produce similar symptoms but usually have different underlying mechanisms or presentations. For instance, complicated migraines can lead to visual disturbances, but they do not typically cause isolated cranial nerve palsies such as ptosis or ophthalmoplegia. In cavernous sinus thrombosis, while cranial nerve involvement can occur, the symptoms are usually