New Hypotheses on the Pathogenesis of Tolosa-Hunt Syndrome and Drug Therapy
Author(s): Lourdes de Fatima Ibanez Valdes and Humberto Foyaca Sibat*
Abstract
Introduction: Tolosa?Hunt Syndrome (THS) is a steroid?responsive, relapsing?remitting, unilateral headache disorder associated with ipsilateral cranial neuropathies, due to an Idiopathic Granulomatous Inflammation (IGI), which is a type of chronic inflammation characterized by granuloma formation that contains focal accumulations of immune cells, mainly macrophages, almost always in response to foreign substances, persistent infections or idiopathic conditions. These granulomas can sometimes be associated with sarcoidosis, tuberculosis, other infections or immunerelated disorders. In case of THS the granulomatosis is localized in the Cavernous Sinus (CS) leading to Cavernous Sinus Syndrome (CSS), Orbital Apex (OA) or Superior Orbital Fissure (SOF) causing a superior orbital fissure syndrome
Methods: We searched the medical literature, following the guidelines outlined in the PRISMA statement. From 01st, January 1982 to 31st, January 2025, the authors searched the scientific databases, Scopus, Embassy, Medline, and PubMed Central using the following searches: "Tolosa?Hunt syndrome" OR "Orbit apex" OR "Superior orbital fissure" OR "Abducens nerve palsy" OR, OR "Cavernous sinus syndrome" OR “Trigeminal nerve” OR “painful ophthalmoplegia”.
Results: After screening the full?text articles for relevance, n=87 articles were identified through database searching. Records after duplicates removed n=46, Record screened N=33, studies with new proposal of pathogenesis included in final review and meta?analysis n=0. No article proposing a new hypothesis for pathogenesis of idiopathic granulomatous inflammation responding to drug therapy was found when we searched. Therefore, metanalysis was not performed.
Conclusions: As far we know, this is the first study proposing a new hypothesis for idiopathic granulomatous inflammation responding to steroid therapy.
