The Tolosa-Hunt Syndrome—Literature Review: Seven New Cases and a Hypothesis

Abstract

The Tolosa-Hunt syndrome is a superior orbital fissure and/or anterior cavernous sinus syndrome. Because the etiology is unknown, the differential diagnosis is essentially one of localization. The pathological substrate consists of a non-specific inflammation. An exhaustive literature search up to 1 January 1981 yielded altogether 214 cases. Seven personal cases are reported. A consistent pathogenesis is still lacking. Observations made in four cases led to the hypothesis that the syndrome results from dysregulation of the adaptation to stressful events, involving enhanced serotonergic activity which suppresses ACTH secretion and promotes non-specific inflammation of perivascular (venous/arterial) tissue.