• Maria Tsirigotaki, George Ntoulios, Michail Lioumpas, Spyridon Voutoufianakis, and Pelagia Vorgia.
• Neonatal Intensive Care Unit, University Hospital, Heraklion, Crete, Greece.
• Pediatr. Neurol. 2019 Oct 1; 99: 60-63.

BackgroundTolosa-Hunt syndrome (THS) is a rare condition in children characterized by painful ophthalmoplegia caused by inflammation of unknown etiology in the cavernous sinus, superior orbital fissure, or orbital apex. Our main purpose was to report two pediatric cases of THS, a typical one and another extremely rare one preceded by facial palsy.MethodsBoth cases were diagnosed with THS based on the 2013 International Classification of Headache Disorders (ICHD-3 beta) criteria. A literature review was also performed concerning epidemiology, clinical and imaging features, diagnostic criteria, treatment, and outcome of THS with a focus on children.ResultsThe first patient was a 14-year-old boy who presented with third nerve palsy, four weeks after the diagnosis and treatment of peripheral seventh nerve palsy and the second patient was a 10-year-old girl who presented with a five-day history left-sided ptosis, periorbital pain, and diplopia.ConclusionsTHS is a rare condition in pediatric population that requires an extensive evaluation before the final diagnosis is made. Seventh nerve palsy preceding the diagnosis of THS is particularly rare in children. This patient represents only the second reported example of seventh nerve involvement in a child with THS.Copyright © 2019. Published by Elsevier Inc.

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