IntroductionTolosa Hunt syndrome (THS) is a disorder that is related to inflammation of cavernous sinus (CS) as well as superior orbital fissure although the exact etiology is unknown.1 THS affects any age group (10-80 yr.) and can present with headache, ophthalmoplegia, oculomotor nerve palsies or even loss of visual acuity. The duration of symptoms ranges from days to weeks and they can be ipsilateral or even contralateral. Moreover, recurrence of symptoms has been noted in some cases despite the initial remission.Currently, the neuroimaging modalities that are performed for the diagnosis of THS are MRI and high-resolution CT scans. However, the review of the literature shows that CT scan is less sensitive than MRI scan. 4 Other laboratory tests performed in cases of suspected THS are blood tests (complete blood count, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)). THS seems to be associated with leukocytosis and raised erythrocytes sendimentation rate5. Usually the treatment for THS involves intravenous corticosteroid administration. However, some studies have reported the efficacy of immunosuppression therapy such as cyclosporin or methotrexate6 while even infliximab has been reported as a successful treatment to a patient with steroid resistant THS.7THS is a diagnosis of exclusion, as other causes can mimic this condition. The differential diagnosis includes neoplastic conditions such as meningioma or chordoma, vascular conditions such as intracavernous artery or posterior artery aneurysms, and finally inflammatory conditions such as sinusitis, or sarcoidosis5. Therefore, every patient should be evaluated thoroughly before the diagnosis is confirmed.Cavernous carotid aneurysm (CCA) accounts for 2-9% of all internal carotid aneurysms. The causes for CCA include trauma, inflammation or idiopathic. Usually patients are asymptomatic in the first stages of the aneurysm but as it is enlarged the patients manifest diplopia, ptosis, ophthalmoplegia. Finally, one must underline the possibility of aneurysm rupture, that requires prompt medical intervention and in the majority of cases can be fatal.In our study we present a patient suffering from an intracavernous aneurysm (ICA) mimicking Tolosa Hunt syndrome.